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

Anette M Hammerum,Claus Østergaard,Louise Roer,Barbara Juliane Holzknecht,Bent L Røder,Turid Snekloth Søndergaard,Anne Kjerulf,Karina Lauenborg Møller,Anna Henius,Hülya Kaya,Lone Jannok Porsbo,Frank Hansen,Ulrik S Justesen,Philip K Thomsen,Mikala Wang,Lillian Søes,Henrik Hasman,Brian Kristensen

doi:10.2807/1560-7917.es.2020.25.18.1900742

Abstract

BackgroundCarbapenemase-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.AimMolecular characterisation and epidemiological investigation of OXA-244-producing E. coli isolates from January 2016 to August 2019.MethodsFor 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).ResultsIn 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.ConclusionImport 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.

Highlights

Carbapenems are used for treatment of infections with multi-resistant Gram-negative bacteria, e.g. extendedspectrum beta-lactamase (ESBL)-producing Escherichia coli
From January 2016 to August 2019, 24 OXA-244producing E. coli isolates were detected in 23 patients in Denmark (Figure 1)
From one of the patients, an OXA-244-producing E. coli and an OXA-244/NDM-5producing E. coli were obtained from the same faecal sample; both isolates were included in the study (Table 1)

Summary

Introduction

Carbapenems are used for treatment of infections with multi-resistant Gram-negative bacteria, e.g. extendedspectrum beta-lactamase (ESBL)-producing Escherichia coli. In comparison to OXA-48, OXA-244 has a single amino acid substitution (Arg-222-Gly) and has reduced carbapenemase activity [2]. It was first described in Spain from a Klebsiella pneumoniae isolate in 2013 [2]. An increase in OXA-244-producing E. coli isolates has been seen in the national surveillance of carbapenemase-producing organisms in Denmark. Among the 23 patients, 13 reported travelling before detection of the E. coli isolates, with seven having visited countries in Northern Africa. It was not possible to point at a single country or a community source as risk factor for acquiring OXA-244-producing E. coli

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