Cross-border emergence of clonal lineages of ST38 Escherichia coli producing the OXA-48-like carbapenemase OXA-244 in Germany and Switzerland.
BACKGROUND
Carbapenemase-producing Gram-negative bacteria cause infections that are difficult to treat and represent a rising threat to healthcare systems worldwide. This study analysed isolates of Escherichia coli (E. coli), a species associated with nosocomial-acquired and community-acquired infections, from hospitals in Germany and Switzerland exhibiting a slight decrease in susceptibility to carbapenems.


METHODS
E. coli strains from Germany and Switzerland, obtained mainly in 2019, were first screened for carbapenemase genes by PCR and subsequently whole-genome-sequenced and analysed for their clonal relationship using multilocus sequence typing, single nucleotide polymorphisms, virulence and antibiotic-resistance gene content.


RESULTS
The analysis revealed the presence of extended β-lactamase (ESBL)-producing E. coli clones producing OXA-244, a point-mutation derivative of OXA-48, with a predominance of isolates exhibiting the sequence type (ST) ST38 in both Germany and Switzerland. These clustered exclusively into two distinct lineages: one encoding CTX-M-27, a recently emerged extended-spectrum β-lactamase, and the other CTX-M-14b. All OXA244/CTX-M-27 ST38 isolates harboured the Dr adhesin operon and a representative isolate exhibited a diffuse adherence (DAEC) phenotype and was invasive for Hela cells.


CONCLUSION
Clonal lineages of ST38 are members of E. coli phylogenetic group D commonly associated with extra-intestinal infections. Their increased isolation in two different European countries indicates ongoing spread of ST38 ESBL-producing and OXA-244-producing E. coli clonal lineages. It is possible that members of the multidrug-resistant DEAC ExPEC group have expanded globally, but that this is currently underreported because of the inherent difficulty in detecting isolates expressing the OXA-244 allele.
['Falgenhauer|Linda|L|', 'Nordmann|Patrice|P|', 'Imirzalioglu|Can|C|', 'Yao|Yancheng|Y|', 'Falgenhauer|Jane|J|', 'Hauri|Anja M|AM|', 'Heinmüller|Petra|P|', 'Chakraborty|Trinad|T|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000900:Anti-Bacterial Agents D001422:Bacterial Adhesion D001426:Bacterial Proteins D015780:Carbapenems D045744:Cell Line, Tumor D002675:Child, Preschool D003428:Cross Infection D024901:Drug Resistance, Multiple, Bacterial D004926:Escherichia coli D004927:Escherichia coli Infections D029968:Escherichia coli Proteins D005260:Female D016680:Genome, Bacterial D005858:Germany D006367:HeLa Cells D006801:Humans D007223:Infant D008297:Male D008826:Microbial Sensitivity Tests D008875:Middle Aged D013557:Switzerland D000073336:Whole Genome Sequencing D001618:beta-Lactamases
Escherichia coli OXA-244 Carbapenemase-producers CTX-M-27/14b Diffusely adhering E. coli (DAEC)