Repeat‑Driven Plasmid Deletions Cause Within‑Patient Carbapenem Heteroresistance in Klebsiella pneumoniae

A single‑patient study shows how repeat‑associated deletion of a blaNDM‑1 resistance module in Klebsiella pneumoniae produced divergent carbapenem phenotypes among otherwise closely related isolates. Stable genomes, a validated 10.5‑kb plasmid deletion, and growth differences highlight how structural plasmid variation can drive clinically relevant heteroresistance.

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https://www.sciencedirect.com/science/article/pii/S266651742600115X