Background: We recently reported the complete sequence of a bla _KPC-2- and rmtB -carrying IncFII-family plasmid p675920-1 with the pKPC-LK30/pHN7A8 hybrid structure. Comparative genomics of additional sequenced plasmids with similar hybrid structures and their prevalence in bla _KPC-carrying Klebsiella pneumoniae  strains from China were investigated in this follow-up study. 
Methods: A total of 51 bla _KPC-carrying K. pneumoniae  strains were isolated from 2012 to 2016 from five Chinese hospitals and genotyped by multilocus sequence typing. The bla _KPC-carrying plasmids from four representative strains were sequenced and compared with p675920-1 and pCT-KPC. Plasmid transfer, carbapenemase activity determination, and bacterial antimicrobial susceptibility test were performed to characterize resistance phenotypes mediated by these plasmids. The prevalence of pCT-KPC-like plasmids in these bla _KPC-carrying K. pneumoniae  strains was screened by PCR.
Result: The six KPC-encoding plasmids p1068-KPC, p20049-KPC, p12139-KPC and p64917-KPC (sequenced in this study) and p675920-1 and pCT-KPC slightly differed from one another due to deletion and acquisition of various backbone and accessory regions. Two major accessory resistance regions, which included the bla _KPC-2 region harboring bla _KPC-2 (carbapenem resistance) and bla _SHV-12 (β-lactam resistance), and the MDR region carrying rmtB  (aminoglycoside resistance), fosA3  (fosfomycin resistance), bla _TEM-1B (β-lactam resistance) and bla _CTX-M-65 (β-lactam resistance), were found in each of these six plasmids and exhibited several parallel evolution routes. The pCT-KPC-like plasmids were present in all the 51 K. pneumoniae  isolates, all of which belonged to CG258.
Conclusion: There was clonal dissemination of K. pneumoniae  CG258 strains, harboring bla _KPC-2- and rmtB -carrying IncFII-family pKPC-LK30/pHN7A8 hybrid plasmids, among multiple Chinese hospitals.
Keywords: Klebsiella pneumoniae , multidrug resistance, carbapenemase, plasmids