Oral Presentation BACPATH 2019

Polymyxin resistance: Deciphering the interplay of different lipid A modifications in Klebsiella pneumoniae (#55)

Sue Chin Nang 1 , Meiling Han 1 , Von Torres 1 , Yan Zhu 1 , ChongShan Dai 2 , Tony Velkov 3 , Marina Harper 1 , Jian Li 1
  1. Department of Microbiology, Monash University, Melbourne, Victoria, Australia
  2. College of Veterinary Medicine, China Agricultural University, Haidian, Beijing, China
  3. Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia

Polymyxins are the last resort against multidrug-resistant Gram-negative bacteria; however, polymyxin resistance is emerging, including in a major nosocomial pathogen Klebsiella pneumoniae. The common resistance mechanisms involve lipid A modifications with phosphoethanolamine(pEtN) and 4-amino-4-deoxy-L-arabinose(L-Ara4N) mediated by chromosomal eptA and arnT, respectively. The recent discovery of plasmid-encoded pEtN transferase gene, mcr, indicates potential rapid horizontal dissemination of polymyxin resistance. This study aimed to investigate the interplay between pEtN and L-Ara4N transferase genes, mcr-1eptA and arnT, in conferring polymyxin resistance in K. pneumoniae. Clinical K. pneumoniae II-503 carrying mcr-1 on a native plasmid was used to construct markerless deletion mutants. Single, double and triple deletions of mcr-1eptA and arnT mutants were generated using the FLP/FRT recombination system. Polymyxin susceptibility was determined using MICs and static time-kill. Lipid A profiling was examined using LC-MS. All the mcr-1-carrying strains were resistant to polymyxin B with MICs of 8 mg/L, and static time-kills with polymyxin B at 8 mg/L were ineffective, indicating that the mcr-1 was the predominant polymyxin resistance mechanism. Reduced MICs of 0.5mg/L was observed for mutants with mcr-1 deleted. The static time-kills revealed significant killing of all mcr-1-deletion mutants with >3-log10cfu/mL reduction in bacterial viability at 1h following treatment. However, by 16h all these mutants demonstrated regrowth to the level similar to the control (~9 log10cfu/mL), with the exception of II-503Δmcr-1ΔeptAΔarnT which regrew to only 5.7±0.7 log10cfu/mL. Following regrowth, L-Ara4N-modified lipid A species were present in mutants that retained arnT but lacked mcr-1 (II-503Δmcr-1 and II-503Δmcr-1ΔeptA), while no modified lipid A species were observed in II-503Δmcr-1ΔarnT and II-503Δmcr-1ΔeptAΔarnT. In conclusion, mcr-1 and arnT, but not eptA, have major roles in conferring resistance towards polymyxin in K. pneumoniae II-503. The regrowth of the mutants lacking of both mcr-1 and arnT could due to other resistance mechanisms, which is currently under investigation using lipidomics and transcriptomics.