Abundance of Multidrug Resistance Efflux Pumps in the Urinary Metagenome of Kidney Transplant Patients

Antibiotic resistance including the emergence of multidrug resistant microbes has become a public health crisis. In this study, we analyzed the antibiotic resistance genes (ARGs) in the urinary metagenome of the kidney transplant and healthy subjects using metagenomic shotgun sequencing. Our data suggest an increased abundance of antibiotic resistance genes in the kidney transplant subjects. In addition, the antibiotic resistance genes identified in the transplant subjects were predominantly composed of multidrug efflux pumps (MDEPs) which are evolutionarily ancient, commonly encoded on chromosomes rather than plasmids, and have a low rate of mutation. Since the MDEPs had a low abundance in the healthy subjects, we speculate that the MDEPs may enhance the fitness of bacteria to survive in the high stress environment of transplantation that includes multiple stressors including surgery, antibiotics, and immunosuppressive agents.