Dynamic evolution and inter-species transfer of blaNDM-5 plasmid in vivo in a single patient

The rapid spread of carbapenem-resistant Enterobacterales (CRE) has become an on-going public health concern worldwide [1]. Intra-species and inter-species horizontal transfers of genes encoding carbapenemases are important for the spread of CRE [2]. However, direct evidence of in vivo transfer is challenging to obtain because it is difficult to identify the original donor strain which provides a new resistance gene to a recipient strain. Here, we characterized three carbapenem-resistant species of Enterobacteriales from a single patient and provided direct evidence of in vivo inter-species transfer of blaNDM-5.