Enterobacteriaceae producing OXA-48-like carbapenemases in Poland, 2013-January 2017

To analyse OXA-48 (OXA-48/181)-type carbapenemase-producing Enterobacteriaceae reported in Poland from 2013 until January 2017. Bacterial isolates were typed by PFGE and MLST. Genes coding for OXA-48/181 types and other beta-lactamases were amplified and sequenced. Mobile elements with bla(OXA-48/181)-like genes were PCR mapped. bla(OXA-48/181)-carrying plasmids were characterized by nuclease S1-hybridization profiling, transfer assays and PCR-based replicon typing, while the chromosomal location of the genes was confirmed by the I-CeuI analysis. Fifty-four isolates from 52 patients in 20 hospitals (14 cities) were included, in 14 cases having probable foreign origins indicated. The organisms were genetically diverse and represented numerous pandemic clones, including Klebsiella pneumoniae ST395 (n = 23), ST11, ST15 and ST101, Escherichia coli ST38, ST410 and ST648, and Enterobacter cloacae complex ST78. These produced OXA-48 (n = 49), OXA-181 (n = 4) or OXA-232 (n = 1). One of five K. pneumoniae ST395 pulsotypes caused a multicentre outbreak with 18 cases, which significantly contributed to the total number of patients. Depending on the variant, the bla(OXA-48/181)-like genes were parts of the Tn1999-, Tn2013- or Tn2016-like transposons, with bla(OXA-48) found in an ISEcp1-associated module (Tn2016-like) for the first time. Three genotypes, including E. coli ST38, had chromosomal bla(OXA-48) genes, while others carried transmissible IncL (60 kb; bla(OXA-48); n = 30), IncM (80-95 kb; bla(OXA-48); n = 4), IncX3 (50 kb; bla(OXA-181); n = 4) or non-typeable (90-160 kb; bla(OXA-48) or bla(OXA-232)) plasmids. Even though OXA-48/181 producers seem to occur infrequently in Poland, their epidemiology has been marked by various phenomena, namely multiple imports, several limited transmissions plus one larger clonal outbreak, and possible plasmid transfers.