Surveillance of OXA-244-producing Escherichia coli and epidemiologic investigation of cases, Denmark, January 2016 to August 2019

Abstract

Background: Carbapenemase-producing Escherichia coli are increasing worldwide. In recent years, an increase in OXA-244-producing E. coli isolates has been seen in the national surveillance of carbapenemase-producing organisms in Denmark. Aim: Molecular characterisation and epidemiological investigation of OXA-244-producing E. coli isolates from January 2016 to August 2019. Methods: For the epidemiological investigation, data from the Danish National Patient Registry and the Danish register of civil registration were used together with data from phone interviews with patients. Isolates were characterised by analysing whole genome sequences for resistance genes, MLST and core genome MLST (cgMLST). Results: In total, 24 OXA-244-producing E. coli isolates were obtained from 23 patients. Among the 23 patients, 13 reported travelling before detection of the E. coli isolates, with seven having visited countries in Northern Africa. Fifteen isolates also carried an extended-spectrum beta-lactamase gene and one had a plasmid-encoded AmpC gene. The most common detected sequence type (ST) was ST38, followed by ST69, ST167, ST10, ST361 and ST3268. Three clonal clusters were detected by cgMLST, but none of these clusters seemed to reflect nosocomial transmission in Denmark. Conclusion: Import of OXA-244 E. coli isolates from travelling abroad seems likely for the majority of cases. Community sources were also possible, as many of the patients had no history of hospitalisation and many of the E. coli isolates belonged to STs that are present in the community. It was not possible to point at a single country or a community source as risk factor for acquiring OXA-244-producing E. coli.

Emergence of carbapenem-resistant ST131 Escherichia coli carrying blaOXA-244 in Germany, 2019 to 2020

“…Recently, several federal states in Germany reported a rise in detection of community-acquired infections with ST38 OXA-244-producing E. coli [17]. Similar observations have been reported in other European countries [4,5,[19][20][21].…”

“…In Germany and other neighbouring countries in Europe, bla OXA-244 is predominantly found in ST38 E. coli [4,17,19,21,22]. Surveillance data from Denmark and France reported the presence of bla OXA-244 in other clonal groups (ST10, ST38, ST69, ST167, ST10, ST361 and ST 3268) [21,23], but to the best of our knowledge the presence of bla OXA-244 in ST131 E. coli in Europe has not been reported before. Besides being responsible for serious extra-intestinal infections, the development of resistance to carbapenems in the ST131 E. coli clonal lineage, is particularly worrisome as carbapenems are often the last line of therapy for life-threatening infections [2,24].…”

Genetic Plurality of OXA/NDM-Encoding Features Characterized From Enterobacterales Recovered From Czech Hospitals

“…Studies from Italy have described the import of NDM-1-producing K. pneumoniae isolates from Egypt ( Principe et al, 2016 ; Nucleo et al, 2020 ). Additionally, the import of OXA-244-producing E. coli isolates from countries in Northern Africa was observed in a surveillance from Denmark ( Hammerum et al, 2020 ). Finally, two studies have documented the spread of NDM-1-producing K. pneumoniae isolates in Mauritius ( Poirel et al, 2012 ; Holman et al, 2017 ), speculating a link with India, due to the geographical and cultural links between the two countries.…”

Rapid spread of OXA-244-producing Escherichia coli ST38 in Germany: insights from an integrated molecular surveillance approach; 2017 to January 2020

“…Multiple transmission hypotheses can be considered regarding the spread of OXA-244-producing E. coli isolates. The wide dissemination of these isolates in Europe [10,16,17] demonstrates the urgent need for additional investigations including additional data sources as well as enhanced screening capabilities [3].…”