“One Health”-based epidemiological investigation reveals the emergence of carbapenem-resistant Morganella spp. across diverse ecological niches

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Objectives To investigate the prevalence, genomic relatedness, and resistance characteristics of carbapenemase-gene-positive Morganella spp. (CRM) across human, animal, fly, and aquatic sources. Methods A total of 163 Morganella isolates were collected from humans (n=124), animals (n=5), flies (n=21), aquatic environment (n=13) across 13 provinces or municipalities during 2018-2024. A subset of 71 representative isolates was subjected to antimicrobial susceptibility testing (AST), whole-genome sequencing and conjugation experiments. Results Among 163 isolates, 18 were carbapenemase-gene-positive: 15 carried bla NDM-1 alone, two carried bla KPC-2 alone, and one carried both genes. They were recovered from humans, flies, and hospital sewage. Five isolates carried bla PER-4 ; four carbapenemase-negative carriers were resistant to both ceftazidime/avibactam and aztreonam/avibactam. The aac(3)-IV gene was associated with high apramycin MICs and was most frequent in animal- and fly-derived isolates. Phylogenetic analysis showed diverse lineages, with limited low-SNP links between human and urban-river isolates. bla NDM-1 was transferred successfully from 11 of 16 donor isolates. Conclusion CRM occur across multiple One Health niches. The findings highlight environmental and non-human reservoirs as potential contributors to their dissemination and identify bla PER-4 and aac(3)-IV as resistance-associated genes requiring further study.

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