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Published on: March 3, 2023
Enterobacteriaceae producing OXA-48-like carbapenemases in Poland, 2013-January 2017
R Izdebski1, A Baraniak1, D Zabicka2
1Department of Molecular Microbiology, National Medicines Institute, 00-725 Warsaw, Poland.
Objectives:
To analyse OXA-48 (OXA-48/181)-type carbapenemase-producing Enterobacteriaceae reported in Poland from 2013 until January 2017.
Methods:
Bacterial isolates were typed by PFGE and MLST. Genes coding for OXA-48/181 types and other β-lactamases were amplified and sequenced. Mobile elements with blaOXA-48/181-like genes were PCR mapped. blaOXA-48/181-carrying plasmids were characterized by nuclease S1-hybridization profiling, transfer assays and PCR-based replicon typing, while the chromosomal location of the genes was confirmed by the I-CeuI analysis.
Results:
Fifty-four isolates from 52 patients in 20 hospitals (14 cities) were included, in 14 cases having probable foreign origins indicated. The organisms were genetically diverse and represented numerous pandemic clones, including Klebsiella pneumoniae ST395 (n = 23), ST11, ST15 and ST101, Escherichia coli ST38, ST410 and ST648, and Enterobacter cloacae complex ST78. These produced OXA-48 (n = 49), OXA-181 (n = 4) or OXA-232 (n = 1). One of five K. pneumoniae ST395 pulsotypes caused a multicentre outbreak with 18 cases, which significantly contributed to the total number of patients. Depending on the variant, the blaOXA-48/181-like genes were parts of the Tn1999-, Tn2013- or Tn2016-like transposons, with blaOXA-48 found in an ISEcp1-associated module (Tn2016-like) for the first time. Three genotypes, including E. coli ST38, had chromosomal blaOXA-48 genes, while others carried transmissible IncL (∼60 kb; blaOXA-48; n = 30), IncM (∼80-95 kb; blaOXA-48; n = 4), IncX3 (∼50 kb; blaOXA-181; n = 4) or non-typeable (∼90-160 kb; blaOXA-48 or blaOXA-232) plasmids.
Conclusions:
Even though OXA-48/181 producers seem to occur infrequently in Poland, their epidemiology has been marked by various phenomena, namely multiple imports, several limited transmissions plus one larger clonal outbreak, and possible plasmid transfers.
Insights
OXA-48/181-type carbapenemase-producing Enterobacteriaceae are infrequent in Poland but exhibit diverse epidemiology. The study identified multiple imports, transmissions, and a significant clonal outbreak, highlighting the spread of these resistant organisms.
Area of Science:
- Microbiology
- Molecular biology
- Epidemiology
Background:
- Carbapenemase-producing Enterobacteriaceae (CPE) pose a significant global health threat.
- OXA-48-type carbapenemases are increasingly reported worldwide, contributing to antimicrobial resistance.
- Surveillance of CPE, including OXA-48 producers, is crucial for understanding their epidemiology and controlling spread.
Purpose of the Study:
- To analyze the epidemiology of OXA-48 (OXA-48/181)-type carbapenemase-producing Enterobacteriaceae in Poland between 2013 and January 2017.
- To characterize the genetic features and mobile genetic elements associated with blaOXA-48/181-like genes.
- To investigate the transmission dynamics and sources of OXA-48-producing Enterobacteriaceae in Poland.
Main Methods:
- Bacterial isolates were identified and characterized using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).
- Genes encoding OXA-48/181-type carbapenemases and other beta-lactamases were amplified and sequenced.
- Plasmids carrying blaOXA-48/181-like genes were analyzed using S1-hybridization, transfer assays, and PCR-based replicon typing; chromosomal locations were confirmed by I-CeuI analysis.
Main Results:
- Fifty-four isolates from 52 patients across 20 hospitals were analyzed, with 14 cases suspected of foreign origin.
- Diverse pandemic clones were identified, including Klebsiella pneumoniae ST395 (n=23), Escherichia coli ST38, ST410, ST648, and Enterobacter cloacae complex ST78.
- OXA-48 was the predominant carbapenemase (n=49), followed by OXA-181 (n=4) and OXA-232 (n=1). A multicentre outbreak involved 18 cases of K. pneumoniae ST395.
- blaOXA-48/181-like genes were located on various transposons (Tn1999-, Tn2013-, Tn2016-like) and plasmids (IncL, IncM, IncX3, non-typeable), with some genes found on the chromosome.
Conclusions:
- OXA-48/181-type carbapenemase producers are infrequent in Poland but demonstrate complex epidemiology.
- The epidemiology is characterized by multiple introductions, limited transmissions, a significant clonal outbreak, and potential plasmid-mediated spread.
- These findings underscore the importance of ongoing surveillance and infection control measures to manage the spread of carbapenemase-producing Enterobacteriaceae.
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