%0 Journal Article %A Bielli, Alessandra %A Piazza, Aurora %A Cento, Valeria %A Comandatore, Francesco %A Lepera, Valentina %A Gatti, Milo %A Brioschi, Paolo %A Vismara, Chiara %A Bandi, Claudio %A Perno, Carlo Federico %T In vivo acquisition and risk of inter-species spread of blaKPC-3-plasmid from Klebsiella pneumoniae to Serratia marcescens in the lower respiratory tract %D 2020 %J Journal of Medical Microbiology, %V 69 %N 1 %P 82-86 %@ 1473-5644 %R https://doi.org/10.1099/jmm.0.001113 %K plasmid transfer %K Serratia marcescens %K KPC-3 %I Microbiology Society, %X In recent years, Serratia marcescens has emerged as an important agent of hospital-acquired infections, such as pneumonia, urinary tract infection, septicaemia and meningitis, particularly in vulnerable patients. Compared to Klebsiella pneumoniae and Escherichia coli , S. marcescens is less commonly associated with bla KPC genes, yet few cases of plasmid transmission at the gastrointestinal level from K. pneumoniae carbapenemase (KPC)-producing Enterobacterales to S. marcescens have been described. Here we report a case of in vivo acquisition, during a 3-month period of hospitalization in the intensive care unit, of a bla KPC-3 gene carried by a pKpQIL-IT plasmid, and its probable transmission at the bronchial level among different species of Enterobacterales , including K. pneumoniae and S. marcescens . By using whole genome sequence analyses we were able provide insight into the dynamics of carbapenem-resistance determinants acquisition in the lower respiratory tract, a novel anatomical region for such plasmid transmission events, that usually involve the gastrointestinal tract. The co-presence at the same time of both wild-type and resistant Enterobacterales could have been the critical factor leading to the spread of plasmids harbouring carbapenem-resistance genes, of particular importance during surveillance screenings. The possibility of such an event may have significant consequences in terms of antimicrobial treatment, with a potential limitation of therapeutic options, thereby further complicating the clinical management of high-risk critically ill patients. %U https://www.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.001113