Genomic characterization of plasmids harboring <i>bla</i> _NDM-1, <i>bla</i> _NDM-5, and <i>bla</i> _NDM-7 carbapenemase alleles in clinical <i>Klebsiella pneumoniae</i> in Pakistan

Infections caused by NDM-producing <i>Klebsiella pneumoniae</i> are a significant challenge to treat and represent a crucial health burden in low- and middle-income countries (LMICs). Most of the <i>bla</i>_NDM are located on plasmids that promote horizontal gene transfer. However, there is a lack of comprehensive information on the genetic context of the NDM-carrying plasmids in Pakistan. This study presents a detailed analysis of seven NDM-plasmids in clinical <i>K. pneumoniae</i> isolates, shedding light on their high-risk sequence types and multiple resistance determinants. We also describe the plasmid-bearing NDM alleles (<i>bla</i>_NDM-1, <i>bla</i>_NDM-5, and <i>bla</i>_NDM-7). Notably, we are the first to report <i>bla</i>_NDM-7 on the hybrid IncFIB/IncHI1B backbone in Pakistan, a plasmid that has rarely been reported previously globally. Understanding the plasmid genomic landscape is paramount to comprehensively understanding the AMR scenario in this LMIC.