Question 1 · Hard
In a neonatal ICU, carbapenem-resistant Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae are isolated from five babies. Typing shows that the isolates of each species are unrelated strains, but all carry blaNDM-1 on the same large plasmid with a transfer region. The most likely way resistance spread is:
- ATransformation with DNA from dead cells
- BIndependent mutation in each organism
- CConjugal transfer of the plasmid between species
- DClonal spread of a single resistant strain
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Answer: C · Conjugal transfer of the plasmid between species
The same plasmid in unrelated strains of three species points to horizontal gene transfer. A large plasmid with a transfer region is conjugative, so it moves by direct cell-to-cell contact, often in the gut. Clonal spread would give one strain, and independent mutation would not produce the identical acquired gene on the same plasmid. Infection control must target the plasmid as well as the strains.
- A: Transformation is inefficient in Enterobacterales and does not fit a large plasmid.
- B: blaNDM-1 is an acquired gene, not a mutation of native genes.
- D: Typing showed unrelated strains, so this is not one clone.