Focusing on the urgent clinical problem of increasing carbapenem resistance in Enterobacteriaceae we have been evaluating detection methods in clinical microbiology and molecular transmission of carbapenemase genes for the last twelve years. Molecular characterization has included analysis of mobile resistance mechanisms with evaluation of plasmid evolution and mobility across species with next generation sequencing paired with more traditional techniques.  During the talk a real world setting in which a plasmid and transposon mediated antimicrobial resistance gene transfer has occurred will act as a backdrop for understanding the different molecular approaches. We will compare and contrast the different molecular and next generation sequencing techniques for evaluating gene exchange in this context.  Through this real world example of ongoing hospital transmission involving the hospital environment and patients we can compare the advantages and disadvantages of different sequencing approaches to understand the challenges of molecular epidemiology of antimicrobial resistance transmission when horizontal gene transfer occurs.

Learning Objectives:

1. Understand the primary mechanisms of horizontal gene transfer between strains and species

2. Describe why horizontal gene transfer can more quickly disseminate antimicrobial resistance

3. Understand how long read and short read sequencing may be needed to describe the genetic context of horizontal gene transfer stting in which a plasmid mediated transmission can be seen