Probable Three-Species In Vivo Transfer of bla NDM-1 in a Single Patient in Greece: Occurrence of NDM-1-Producing Klebsiella pneumoniae , Proteus mirabilis , and Morganella morganii .

NDM carbapenemase-encoding genes disseminate commonly among Enterobacterales through transferable plasmids carrying additional resistance determinants. Apart from the intra-species dissemination, the inter-species exchange of plasmids seems to play an additional important role in the spread of bla NDM . We here present the genetics related to the isolation of three species ( Klebsiella pneumoniae , Proteus mirabilis , and Morganella morganii ) harboring the bla NDM-1 gene from a single patient in Greece. Bacterial identification and antimicrobial susceptibility testing were performed using the Vitek2. Whole genome sequencing and bioinformatic tools were used to identify resistance genes and plasmids. Bla NDM-1 harboring plasmids were found in all three isolates. Moreover, the plasmid constructs of the respective incomplete or circular contigs showed that the bla NDM-1 and its neighboring genes form a cluster that was found in all isolates. Our microbiological findings, together with the patient's history, suggest the in vivo transfer of the bla NDM-1 -containing cluster through three different species in a single patient.