Emergence of a Multidrug-Resistant Enterobacter hormaechei Clinical Isolate from Egypt Co-Harboring mcr-9 and bla VIM-4 .

This study describes the first full genomic sequence of an mcr-9 and bla(VIM-4)-carrying multidrug-resistant Enterobacter hormaechei clinical isolate from Egypt. The strain was isolated in April 2015 from the sputum of a patient in Cairo, Egypt. The mcr-9 and bla(VIM-4) genes were identified by PCR screening and DNA sequencing; the isolate was subjected to antimicrobial susceptibility testing, conjugation experiments, and whole genomic sequencing. mcr-9 and bla(VIM-4) were carried by an IncHI2 plasmid, pAMS-38a (281,121 bp in size); the plasmid also carried genes conferring resistance against sulfonamides (sul1), quinolones (qnrA1), trimethoprim (dfrA1), beta-lactams (bla(TEM-1B)), aminoglycosides (aac (6')-II, aadA23, aadA2b, and ant(2")-Ia). The strain was susceptible to colistin (MIC, <0.25 mu g/mL); this could be due to the absence of the qseC/qseB regulatory system located downstream of mcr-9 in Enterobacterales, which is involved in the induction of colistin-resistance. The genetic context of mcr-9 and bla(VIM-4) was identified as IS1-mcr-9-IS903-pcoS- increment pcoE-rcnA and intI1-bla(VIM-4-)aac (6')-II-dfrA1- increment aadA23-smr-ISPa21-qacE increment 1, respectively. This is the first report of an mcr-9 and bla(VIM-4) /IncHI2-carrying multidrug-resistant E. hormaechei clinical isolate from Africa and the Middle East. Plasmids of the IncHI2 group and the two insertion sequences (IS1, and IS903) might be the main vehicles for dissemination of mcr-9. Further screening for mcr-9 is essential for identifying its incidence and to prevent its dissemination.