Outbreaks Open Access
Like 0


Infections with OXA-244-carbapenemase-producing with sequence type (ST)38 have recently increased in Europe. Due to its low-level activity against carbapenems, OXA-244 can be difficult to detect. Previous assessments have not revealed a clear source and route of transmission for OXA-244-producing , but there are indications of non-healthcare related sources and community spread. Here we report a hospital-associated outbreak of OXA-244-producing ST38 involving three hospitals in Western Norway in 2020. The outbreak occurred over a 5-month period and included 12 cases identified through clinical (n = 6) and screening (n = 6) samples. The transmission chain was unclear; cases were identified in several wards and there was no clear overlap of patient stay. However, all patients had been admitted to the same tertiary hospital in the region, where screening revealed an outbreak in one ward (one clinical case and five screening cases). Outbreak control measures were instigated including contact tracing, isolation, and screening; no further cases were identified in 2021. This outbreak adds another dimension to the spread of OXA-244-producing ST38, illustrating this clone’s ability to establish itself in the healthcare setting. Awareness of challenges concerning OXA-244-producing diagnostic is important to prevent further spread.


Article metrics loading...

Loading full text...

Full text loading...



  1. Pitout JDD, Peirano G, Kock MM, Strydom KA, Matsumura Y. The global ascendency of OXA-48-type carbapenemases. Clin Microbiol Rev. 2019;33(1):e00102-19.  https://doi.org/10.1128/CMR.00102-19  PMID: 31722889 
  2. Rima M, Emeraud C, Bonnin RA, Gonzalez C, Dortet L, Iorga BI, et al. Biochemical characterization of OXA-244, an emerging OXA-48 variant with reduced β-lactam hydrolytic activity. J Antimicrob Chemother. 2021;76(8):2024-8.  https://doi.org/10.1093/jac/dkab142  PMID: 33993262 
  3. Emeraud C, Biez L, Girlich D, Jousset AB, Naas T, Bonnin RA, et al. Screening of OXA-244 producers, a difficult-to-detect and emerging OXA-48 variant? J Antimicrob Chemother. 2020;75(8):2120-3.  https://doi.org/10.1093/jac/dkaa155  PMID: 32363407 
  4. Hoyos-Mallecot Y, Naas T, Bonnin RA, Patino R, Glaser P, Fortineau N, et al. OXA-244-producing Escherichia coli isolates, a challenge for clinical microbiology laboratories. Antimicrob Agents Chemother. 2017;61(9):e00818-17.  https://doi.org/10.1128/AAC.00818-17  PMID: 28674064 
  5. Hammerum AM, Porsbo LJ, Hansen F, Roer L, Kaya H, Henius A, et al. Surveillance of OXA-244-producing Escherichia coli and epidemiologic investigation of cases, Denmark, January 2016 to August 2019. Euro Surveill. 2020;25(18):1900742.  https://doi.org/10.2807/1560-7917.ES.2020.25.18.1900742  PMID: 32400363 
  6. Falgenhauer L, Nordmann P, Imirzalioglu C, Yao Y, Falgenhauer J, Hauri AM, et al. Cross-border emergence of clonal lineages of ST38 Escherichia coli producing the OXA-48-like carbapenemase OXA-244 in Germany and Switzerland. Int J Antimicrob Agents. 2020;56(6):106157.  https://doi.org/10.1016/j.ijantimicag.2020.106157  PMID: 32919009 
  7. Masseron A, Poirel L, Falgenhauer L, Imirzalioglu C, Kessler J, Chakraborty T, et al. Ongoing dissemination of OXA-244 carbapenemase-producing Escherichia coli in Switzerland and their detection. Diagn Microbiol Infect Dis. 2020;97(3):115059.  https://doi.org/10.1016/j.diagmicrobio.2020.115059  PMID: 32387849 
  8. Kremer K, Kramer R, Neumann B, Haller S, Pfennigwerth N, Werner G, et al. Rapid spread of OXA-244-producing Escherichia coli ST38 in Germany: insights from an integrated molecular surveillance approach; 2017 to January 2020. Euro Surveill. 2020;25(25):2000923.  https://doi.org/10.2807/1560-7917.ES.2020.25.25.2000923  PMID: 32613940 
  9. Emeraud C, Girlich D, Bonnin RA, Jousset AB, Naas T, Dortet L. Emergence and polyclonal dissemination of OXA-244-producing Escherichia coli, France. Emerg Infect Dis. 2021;27(4):1206-10.  https://doi.org/10.3201/eid2704.204459  PMID: 33755001 
  10. European Centre for Disease Control and Prevention (ECDC). OXA-244-producing Escherichia coli in the European Union/European Economic Area and the UK since 2013, first update. Stockholm: ECDC; 2021.
  11. Samuelsen Ø, Overballe-Petersen S, Bjørnholt JV, Brisse S, Doumith M, Woodford N, et al. , Norwegian Study Group on CPE. Molecular and epidemiological characterization of carbapenemase-producing Enterobacteriaceae in Norway, 2007 to 2014. PLoS One. 2017;12(11):e0187832.  https://doi.org/10.1371/journal.pone.0187832  PMID: 29141051 
  12. Grundmann H, Glasner C, Albiger B, Aanensen DM, Tomlinson CT, Andrasević AT, et al. , European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) Working Group. Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study. Lancet Infect Dis. 2017;17(2):153-63.  https://doi.org/10.1016/S1473-3099(16)30257-2  PMID: 27866944 
  13. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 13.0. Växjö: EUCAST; 2023. Available from: https://www.eucast.org
  14. Ellington MJ, Findlay J, Hopkins KL, Meunier D, Alvarez-Buylla A, Horner C, et al. Multicentre evaluation of a real-time PCR assay to detect genes encoding clinically relevant carbapenemases in cultured bacteria. Int J Antimicrob Agents. 2016;47(2):151-4.  https://doi.org/10.1016/j.ijantimicag.2015.11.013  PMID: 26795023 
  15. Abril D, Bustos Moya IG, Marquez-Ortiz RA, Josa Montero DF, Corredor Rozo ZL, Torres Molina I, et al. First report and comparative genomics analysis of a blaOXA-244-harboring Escherichia coli isolate recovered in the American continent. Antibiotics (Basel). 2019;8(4):222.  https://doi.org/10.3390/antibiotics8040222  PMID: 31766210 
  16. Soliman AM, Ramadan H, Sadek M, Nariya H, Shimamoto T, Hiott LM, et al. Draft genome sequence of a blaNDM-1- and blaOXA-244-carrying multidrug-resistant Escherichia coli D-ST69 clinical isolate from Egypt. J Glob Antimicrob Resist. 2020;22:832-4.  https://doi.org/10.1016/j.jgar.2020.07.015  PMID: 32738341 
  17. Hendrickx APA, Landman F, de Haan A, Witteveen S, van Santen-Verheuvel MG, Schouls LM, The Dutch Cpe Surveillance Study Group. blaOXA-48-like genome architecture among carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in the Netherlands. Microb Genom. 2021;7(5):000512.  https://doi.org/10.1099/mgen.0.000512  PMID: 33961543 
  18. Shimada T, Yamazaki K, Ishihama A. Novel regulator PgrR for switch control of peptidoglycan recycling in Escherichia coli. Genes Cells. 2013;18(2):123-34.  https://doi.org/10.1111/gtc.12026  PMID: 23301696 
  19. Lukas H, Reimann J, Kim OB, Grimpo J, Unden G. Regulation of aerobic and anaerobic D-malate metabolism of Escherichia coli by the LysR-type regulator DmlR (YeaT). J Bacteriol. 2010;192(10):2503-11.  https://doi.org/10.1128/JB.01665-09  PMID: 20233924 
  20. Nordic Committee on Antimicrobial Susceptibilty Testing (NordicAST). Breakpoints for interpretation of MICs and zone diameters. 2023; NordicAST version 13.0.
  21. NORM/NORM-VET. NORM/NORM-VET 2020. Usage of antimicrobial agents and occurrence of antimicrobial resistance in Norway. Tromsø/Oslo; 2021.
  22. Elstrøm P, Astrup E, Hegstad K, Samuelsen Ø, Enger H, Kacelnik O. The fight to keep resistance at bay, epidemiology of carbapenemase producing organisms (CPOs), vancomycin resistant enterococci (VRE) and methicillin resistant Staphylococcus aureus (MRSA) in Norway, 2006 - 2017. PLoS One. 2019;14(2):e0211741.  https://doi.org/10.1371/journal.pone.0211741  PMID: 30716133 
  23. Tofteland S, Naseer U, Lislevand JH, Sundsfjord A, Samuelsen O. A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving Intergenus plasmid diffusion and a persisting environmental reservoir. PLoS One. 2013;8(3):e59015.  https://doi.org/10.1371/journal.pone.0059015  PMID: 23536849 
  24. Manges AR, Geum HM, Guo A, Edens TJ, Fibke CD, Pitout JDD. Global extraintestinal pathogenic Escherichia coli (ExPEC) lineages. Clin Microbiol Rev. 2019;32(3):e00135-18.  https://doi.org/10.1128/CMR.00135-18  PMID: 31189557 
  25. International Organization for Standardization (ISO). Susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility test devices — Part 1: Broth micro-dilution reference method for testing the in vitro activity of antimicrobial agents against rapidly growing aerobic bacteria involved in infectious diseases. Geneva: ISO; 2019. ISO 20776-1:2019.

Data & Media loading...

Supplementary data

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error