Outbreaks Open Access
Like 0


In February 2023, sequence type (ST) 38 producing oxacillinase 244 (OXA-244-Ec ST38) was detected from three patients in a hospital in western Poland. Overall, OXA-244-Ec ST38 was detected from 38 colonised patients in 13 wards between February and June 2023. The outbreak was investigated on site by an infection control team, and the bacterial isolates were characterised microbiologically and by whole genome sequencing. We could not identify the primary source of the outbreak or reconstruct the transmission sequence. In some of the 13 affected wards or their groups linked by the patients’ movement, local outbreaks occurred. The tested outbreak isolates were resistant to β-lactams (penicillins, cephalosporins, aztreonam and ertapenem) and to trimethoprim-sulfamethoxazole. Consistently, apart from , all isolates contained also the and genes, coding for an AmpC-like cephalosporinase and extended-spectrum β-lactamase, respectively, and genes conferring resistance to trimethoprim-sulfamethoxazole, and . Genomes of the isolates formed a tight cluster, not of the major recent European Cluster A but of the older Cluster B, with related isolates identified in Germany. This outbreak clearly demonstrates that OXA-244-Ec ST38 has a potential to cause hospital outbreaks which are difficult to detect, investigate and control.


Article metrics loading...

Loading full text...

Full text loading...



  1. Vila J, Sáez-López E, Johnson JR, Römling U, Dobrindt U, Cantón R, et al. Escherichia coli: an old friend with new tidings. FEMS Microbiol Rev. 2016;40(4):437-63.  https://doi.org/10.1093/femsre/fuw005  PMID: 28201713 
  2. Bush K, Bradford PA. Epidemiology of β-lactamase-producing pathogens. Clin Microbiol Rev. 2020;33(2):e00047-19.  https://doi.org/10.1128/CMR.00047-19  PMID: 32102899 
  3. Bonomo RA, Burd EM, Conly J, Limbago BM, Poirel L, Segre JA, et al. Carbapenemase-producing organisms: a global scourge. Clin Infect Dis. 2018;66(8):1290-7.  https://doi.org/10.1093/cid/cix893  PMID: 29165604 
  4. Boyd SE, Holmes A, Peck R, Livermore DM, Hope W. OXA-48-like β-lactamases: global epidemiology, treatment options, and development pipeline. Antimicrob Agents Chemother. 2022;66(8):e0021622.  https://doi.org/10.1128/aac.00216-22  PMID: 35856662 
  5. David S, Reuter S, Harris SR, Glasner C, Feltwell T, Argimon S, et al. Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread. Nat Microbiol. 2019;4(11):1919-29.  https://doi.org/10.1038/s41564-019-0492-8  PMID: 31358985 
  6. David S, Cohen V, Reuter S, Sheppard AE, Giani T, Parkhill J, et al. Integrated chromosomal and plasmid sequence analyses reveal diverse modes of carbapenemase gene spread among Klebsiella pneumoniae. Proc Natl Acad Sci USA. 2020;117(40):25043-54.  https://doi.org/10.1073/pnas.2003407117  PMID: 32968015 
  7. Poirel L, Bernabeu S, Fortineau N, Podglajen I, Lawrence C, Nordmann P. Emergence of OXA-48-producing Escherichia coli clone ST38 in France. Antimicrob Agents Chemother. 2011;55(10):4937-8.  https://doi.org/10.1128/AAC.00413-11  PMID: 21768512 
  8. Potron A, Poirel L, Dortet L, Nordmann P. Characterisation of OXA-244, a chromosomally-encoded OXA-48-like β-lactamase from Escherichia coli. Int J Antimicrob Agents. 2016;47(1):102-3.  https://doi.org/10.1016/j.ijantimicag.2015.10.015  PMID: 26655033 
  9. Valenza G, Nickel S, Pfeifer Y, Eller C, Krupa E, Lehner-Reindl V, et al. Extended-spectrum-β-lactamase-producing Escherichia coli as intestinal colonizers in the German community. Antimicrob Agents Chemother. 2014;58(2):1228-30.  https://doi.org/10.1128/AAC.01993-13  PMID: 24295972 
  10. Turton JF, Doumith M, Hopkins KL, Perry C, Meunier D, Woodford N. Clonal expansion of Escherichia coli ST38 carrying a chromosomally integrated OXA-48 carbapenemase gene. J Med Microbiol. 2016;65(6):538-46.  https://doi.org/10.1099/jmm.0.000248  PMID: 26982715 
  11. European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment: Increase in OXA-244 -producing Escherichia coli in the European Union/European Economic Area and the UK since 2013, first update. Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-increase-oxa-244-producing-escherichia-coli-eu-eea
  12. 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 
  13. 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 
  14. Notermans DW, Schoffelen AF, Landman F, Wielders CCH, Witteveen S, Ganesh VA, et al. A genetic cluster of OXA-244 carbapenemase-producing Escherichia coli ST38 with putative uropathogenicity factors in the Netherlands. J Antimicrob Chemother. 2022;77(11):3205-8.  https://doi.org/10.1093/jac/dkac307  PMID: 36171716 
  15. Lindemann PC, Pedersen T, Oma DH, Janice J, Grøvan F, Chedid GM, et al. Intraregional hospital outbreak of OXA-244-producing Escherichia coli ST38 in Norway, 2020. Euro Surveill. 2023;28(27):2200773.  https://doi.org/10.2807/1560-7917.ES.2023.28.27.2200773  PMID: 37410380 
  16. 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 
  17. Lee K, Lim YS, Yong D, Yum JH, Chong Y. Evaluation of the Hodge test and the imipenem-EDTA double-disk synergy test for differentiating metallo-β-lactamase-producing isolates of Pseudomonas spp. and Acinetobacter spp. J Clin Microbiol. 2003;41(10):4623-9.  https://doi.org/10.1128/JCM.41.10.4623-4629.2003  PMID: 14532193 
  18. Doi Y, Potoski BA, Adams-Haduch JM, Sidjabat HE, Pasculle AW, Paterson DL. Simple disk-based method for detection of Klebsiella pneumoniae carbapenemase-type β-lactamase by use of a boronic acid compound. J Clin Microbiol. 2008;46(12):4083-6.  https://doi.org/10.1128/JCM.01408-08  PMID: 18923005 
  19. Glupczynski Y, Huang TD, Bouchahrouf W, Rezende de Castro R, Bauraing C, Gérard M, et al. Rapid emergence and spread of OXA-48-producing carbapenem-resistant Enterobacteriaceae isolates in Belgian hospitals. Int J Antimicrob Agents. 2012;39(2):168-72.  https://doi.org/10.1016/j.ijantimicag.2011.10.005  PMID: 22115539 
  20. Poirel L, Héritier C, Tolün V, Nordmann P. Emergence of oxacillinase-mediated resistance to imipenem in Klebsiella pneumoniae. Antimicrob Agents Chemother. 2004;48(1):15-22.  https://doi.org/10.1128/AAC.48.1.15-22.2004  PMID: 14693513 
  21. Bankevich A, Nurk S, Antipov D, Gurevich AA, Dvorkin M, Kulikov AS, et al. SPAdes: a new genome assembly algorithm and its applications to single-cell sequencing. J Comput Biol. 2012;19(5):455-77.  https://doi.org/10.1089/cmb.2012.0021  PMID: 22506599 
  22. Wick RR, Judd LM, Gorrie CL, Holt KE. Unicycler: Resolving bacterial genome assemblies from short and long sequencing reads. PLOS Comput Biol. 2017;13(6):e1005595.  https://doi.org/10.1371/journal.pcbi.1005595  PMID: 28594827 
  23. Wirth T, Falush D, Lan R, Colles F, Mensa P, Wieler LH, et al. Sex and virulence in Escherichia coli: an evolutionary perspective. Mol Microbiol. 2006;60(5):1136-51.  https://doi.org/10.1111/j.1365-2958.2006.05172.x  PMID: 16689791 
  24. Treangen TJ, Ondov BD, Koren S, Phillippy AM. The Harvest suite for rapid core-genome alignment and visualization of thousands of intraspecific microbial genomes. Genome Biol. 2014;15(11):524.  https://doi.org/10.1186/s13059-014-0524-x  PMID: 25410596 
  25. Carattoli A, Zankari E, García-Fernández A, Voldby Larsen M, Lund O, Villa L, et al. In silico detection and typing of plasmids using PlasmidFinder and plasmid multilocus sequence typing. Antimicrob Agents Chemother. 2014;58(7):3895-903.  https://doi.org/10.1128/AAC.02412-14  PMID: 24777092 
  26. Boyd DA, Tyler S, Christianson S, McGeer A, Muller MP, Willey BM, et al. Complete nucleotide sequence of a 92-kilobase plasmid harboring the CTX-M-15 extended-spectrum β-lactamase involved in an outbreak in long-term-care facilities in Toronto, Canada. Antimicrob Agents Chemother. 2004;48(10):3758-64.  https://doi.org/10.1128/AAC.48.10.3758-3764.2004  PMID: 15388431 
  27. Hans JB, Neumann B, Pfennigwerth N, Reichert F, Brinkwirth S, Eisfeld J, et al. Towards an endemic situation: OXA-244-producing Escherichia coli in Germany, 2013-2021. 33rd European Congress of Clinical Microbiology & Infectious Diseases (ECCMID); 15–18 Apr 2023, Copenhagen, Denmark. Abstract P0298. Available from: https://2023.eccmid.org/abstracts/posters-and-poster-sessions

Data & Media loading...

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