A clinical strain with carried by an integrative and conjugative element in China.

Objective: To precisely determine the species of a carbapenem-resistant strain 1809276 isolated from the urine of a Chinese patient and analyze its integrative and conjugative element (ICE) formation mechanism.

Methods: Single-molecule real-time (SMRT) sequencing was carried out on strain 18091276 to obtain the complete chromosome and plasmid (pCN1276) sequences, and average nucleotide identity (ANI) was used for precise species identification. The ICEs in GenBank with the same integrase structure as ICE were aligned. At the same time, the transfer ability of and the antibiotic sensitivity of 18091276 were tested.

Results: This bacterium was , and its drug resistance mechanism is the capture of the gene cassette by the Tn-like type 1 integron (- ) to form In before its capture by the ΔTn-carrying ICE . The acquisition of confers carbapenem resistance to 18091276.

Conclusion: The formation of -carrying ICE , its further integration into the chromosomes, and transposition and recombination of other elements promote bacterial gene accumulation and transmission.