Piperacillin/tazobactam resistance in a clinical isolate of Escherichia coli due to IS 26-mediated amplification of bla _TEM-1B

Abstract

A phenotype of Escherichia coli and Klebsiella pneumoniae, resistant to piperacillin/tazobactam (TZP) but susceptible to carbapenems and 3rd generation cephalosporins, has emerged. The resistance mechanism associated with this phenotype has been identified as hyperproduction of the β-lactamase TEM. However, the mechanism of hyperproduction due to gene amplification is not well understood. Here, we report a mechanism of gene amplification due to a translocatable unit (TU) excising from an IS 26-flanked pseudo-compound transposon, PTn 6762, which harbours bla _TEM-1B. The TU re-inserts into the chromosome adjacent to IS 26 and forms a tandem array of TUs, which increases the copy number of bla _TEM-1B, leading to TEM-1B hyperproduction and TZP resistance. Despite a significant increase in bla _TEM-1B copy number, the TZP-resistant isolate does not incur a fitness cost compared to the TZP-susceptible ancestor. This mechanism of amplification of bla _TEM-1B is an important consideration when using genomic data to predict susceptibility to TZP.

Abstract

An E. coli and K. pneumoniae phenotype resistant to piperacillin/tazobactam has recently emerged. Here, the authors show that hyperproduction of the β-lactamase driving this resistance occurs due to excision and reinsertion of a translocatable unit containing bla _TEM-1B, creating a tandem array.