Resistance evolution of Escherichia coli and blaNDM-5 carrying IncX3 plasmid

Bacterial hosts and conjugative plasmids can undergo resistance evolution under certain concentrations of antimicrobial pressure by reducing the expression of outer membrane proteins or increasing plasmid copy numbers. blaNDM-5-carrying IncX3 plasmids demonstrated high resistance to carbapenems and adaptability to bacterial host, which could enhance their resistance and stability in response to increasing antimicrobial pressure almost at no cost. In the context of One Health, a comprehensive perspective of human-animal-environment health is required to develop strategies for addressing bacterial resistance. Reducing unnecessary antimicrobial drug usage and antibiotic pollution is necessary to minimize the evolution of bacterial resistance.