pRMH760, a precursor of A/C₂ plasmids carrying blaCMY and blaNDM genes.

To investigate the evolution of plasmids in the repA/C2 group carrying genes conferring resistance to cephalosporins (bla(CMY)) or to carbapenems (bla(NDM)) and cephalosporins (bla(CMY)), the sequence of plasmid pRMH760 that lacks the β-lactamase genes was determined and compared to all available A/C2 plasmid sequences. pRMH760 is 170.6 kb and carries several antibiotic resistance genes in a 45.1 kb complex transposon structure located upstream of the rhs gene. In plasmid pR148, the closest relative of pRMH760, the antibiotic resistance island is in the same position but the resistance genes differ. pRMH760 also contains a deletion in the rhs gene. Sequenced A/C2 plasmids containing bla(CMY) or bla(CMY) and bla(NDM) have backbones closely related to the pRMH760/pR148 backbone, and they include resistance islands in the same location, indicating that they arose from a plasmid related to pRMH760/pR148. However, the gene content of this resistance island differs in each case, and the island family was designated ARI-A. The bla(NDM) gene is within ARI-A. The ISEcp1-bla(CMY) fragment is located elsewhere and is always in the same location, consistent with a single acquisition event. Plasmids containing only bla(CMY) carry a second resistance island, designated ARI-B, which includes the sul2 gene and a variable set of further resistance genes. Nine A/C2 plasmids that were not of this type (type 1) were found to have a similar backbone that can be simply distinguished by the presence of two exchanged regions and two insertions. Antibiotic resistance islands in type 2 plasmids are in different locations and have different structures.