Source tracking and global distribution of the mobilized tigecycline resistant gene tet(X)

The emergence of tet(X) genes has compromised the clinical use of the last-line antibiotic tigecycline. We identified 322 (1.21%) tet(X) positive samples from 12,829 human microbiome samples distributed in four continents (Asia, Europe, North America and South America) using retrospective data from worldwide. These tet(X) genes were dominated by tet(X2)-like orthologs but we also identified 12 samples carrying novel tet(X) genes, designed tet(X15) and tet(X16), that were resistant to tigecycline. The metagenomic analysis revealed these tet(X) genes distributed in anaerobes dominated by Bacteroidaceae (78.89%) of human-gut origin. The transmission of these tet(X2)-like orthologs between Bacteroidaceae and Riemerella anatipestifer was primarily promoted by the mobile elements ISBf11 and IS4351. tet(X2)-like orthologs was also developed during transmission by mutation to high-level tigecycline resistant determinants tet(X15) and tet(X16). Further tracing these tet(X) in single bacterial isolate from public repository indicated that tet(X) genes were present as early as 1960s in R. anatipestifer that was the primary tet(X) carrier at early stage (before 2000). The tet(X2) and non-tet(X2) orthologs were primarily distributed in humans and food animals respectively, and non-tet(X2) were dominated by tet(X3) and tet(X4). Genomic comparison indicated these tet(X) genes were likely to be generated during tet(X) transmission between Flavobacteriaceae and E. coli/Acinetobacter spp.., and ISCR2 played a key role in the transmission. These results suggest R. anatipestifer was the potential ancestral source of tet(X) gene. Additionally, Bacteroidaceae of human-gut origin was an important hidden reservoir and mutational incubator for the mobile tet(X) genes that enabled spread to facultative anaerobes and aerobes.