Simultaneous Three Enterobacteriaceae With Different Bla (Ndm-1)-Encoding Plasmids In A Patient Transferred From Mainland China To Taiwan

New-Delhi metallo-beta-lactamase 1 (NDM-1) Enterobacteriaceae are increasing worldwide. Herein, we describe a single patient who carried three unusual NDM-1 carbapenem-resistant Enterobacteriaceae - Enterobacter cloacae (E. cloacae) yielded from a urine specimen and Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. cola) from stool specimens. For E. cloacae, its bla (NDM-1)-encoding plasmid was pKP04NDM with a size of similar to 54 kb replicons with an IncN backbone. For K. pneumoniae, its bla (NDM-1)-encoding plasmid was pNDM-BTR with a size of similar to 59.6 kb and belonged to lncN. For E. coli, its main bla (NDM-1)-encoding plasmid was pIMP-HK1500, and the NDM-1 gene was obtained from a part of pNDM-BTR (8439 bp). These three clinical strains are reported for the first time and are assumed to be imported from mainland China to Taiwan. The three different plasmids were never reported in K. pneumoniae, E. coli, and Citrobacter spp before. Owing to their associated multidrug resistance, appropriate measures of periodic, targeted surveillance, and development of new antimicrobial agents are urgently needed.