title: Molecular Characterization of OXA-48-Like-Producing Enterobacteriaceae in the Czech Republic and Evidence for Horizontal Transfer of pOXA-48-Like Plasmids.
abstract: The aim of this study was to characterize the first cases and outbreaks of OXA-48-like-producing Enterobacteriaceae recovered from hospital settings in the Czech Republic. From 2013 to 2015, 22 Klebsiella pneumoniae isolates, 3 Escherichia coli isolates, and 1 Enterobacter cloacae isolate producing OXA-48-like carbapenemases were isolated from 20 patients. Four of the patients were colonized or infected by two or three different OXA-48-like producers. The K. pneumoniae isolates were classified into nine sequence types (STs), with ST101 being predominant (n = 8). The E. coli isolates were of different STs, while the E. cloacae isolate belonged to ST109. Twenty-four isolates carried blaOXA-48, while two isolates carried blaOXA-181or blaOXA-232Almost all isolates (n = 22) carried blaOXA-48-positive plasmids of a similar size (∼60 kb), except the two isolates producing OXA-181 or OXA-232. In an ST45 K. pneumoniae isolate and an ST38 E. coli isolate, S1 nuclease profiling plus hybridization indicated a chromosomal location of blaOXA-48Sequencing showed that the majority of blaOXA-48-carrying plasmids exhibited high degrees of identity with the pOXA-48-like plasmid pE71T. Additionally, two novel pE71T derivatives, pOXA-48_30715 and pOXA-48_30891, were observed. The blaOXA-181-carrying plasmid was identical to the IncX3 plasmid pOXA181_EC14828, while the blaOXA-232-carrying plasmid was a ColE2-type plasmid, being a novel derivative of pOXA-232. Finally, sequencing data showed that the ST45 K. pneumoniae and ST38 E. coli isolates harbored the IS1R-based composite transposon Tn6237 containing blaOXA-48integrated into their chromosomes. These findings underlined that the horizontal transfer of pOXA-48-like plasmids has played a major role in the dissemination of blaOXA-48in the Czech Republic. In combination with the difficulties with their detection, OXA-48 producers constitute an important public threat.
authors.affiliation: Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Anna
authors.initials: A
authors.lastname: Skalova
authors.affiliation: Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Katerina
authors.initials: K
authors.lastname: Chudejova
authors.affiliation: Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Veronika
authors.initials: V
authors.lastname: Rotova
authors.affiliation: Veterinary Research Institute, Brno, Czech Republic.
authors.forename: Matej
authors.initials: M
authors.lastname: Medvecky
authors.affiliation: Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Vendula
authors.initials: V
authors.lastname: Studentova
authors.affiliation: Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Chudackova
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Lavicka
authors.affiliation: Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Tamara
authors.initials: T
authors.lastname: Bergerova
authors.affiliation: Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.|National Reference Laboratory for Antibiotics, National Institute of Public Health, Prague, Czech Republic.
authors.forename: Vladislav
authors.initials: V
authors.lastname: Jakubu
authors.affiliation: Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.|National Reference Laboratory for Antibiotics, National Institute of Public Health, Prague, Czech Republic.|Department of Clinical Microbiology, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic.
authors.forename: Helena
authors.initials: H
authors.lastname: Zemlickova
authors.affiliation: Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic c.papagiannitsis@gmail.com.|Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Costas C
authors.identifier: 0000-0002-9912-9028
authors.initials: CC
authors.lastname: Papagiannitsis
authors.affiliation: Department of Microbiology, Faculty of Medicine, and University Hospital Pilsen, Charles University, Pilsen, Czech Republic.|Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Hrabak
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism; D002876:Chromosomes, Bacterial / Q000235:genetics; D018153:Czech Republic; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics*; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology / Q000235:genetics; D022761:Gene Transfer, Horizontal / Q000235:genetics; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics; D008826:Microbial Sensitivity Tests; D010957:Plasmids / Q000235:genetics; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: ColE2-like; IncL; IncX3; Klebsiella pneumoniae; OXA-181; OXA-232; Tn1999.2; Tn1999.5