IS26-mediated plasmid and toxin-antitoxin gene convergence in Klebsiella pneumoniae resulting in antibiotic resistance gene loss

To study the within-host plasmid evolution of Klebsiella pneumoniae ST14 that has been cultured from a single patient over four years. The index isolate originally carried NDM-1 and OXA-232 carbapenemases. Over the span of four years, the carbapenemases, along with armA were lost through plasmid rearrangment events and plasmid loss, selectively retaining toxin-antitoxin systems observed in the patient's first isolate.