review · Journal of Clinical Microbiology
Bacterial species such as Klebsiella pneumoniae and Escherichia coli carrying OXA-48-like carbapenemase enzymes are significantly compromising the effectiveness of carbapenem antibiotics worldwide. Different enzyme variants have established endemic footholds globally: OXA-48 is prevalent across the Middle East, North Africa, and parts of Western Europe, while OXA-181 is endemic in Sub-Saharan Africa and the Indian Subcontinent. The rapid expansion of these resistance mechanisms is propelled by both horizontal gene transfer via mobile plasmids and vertical dissemination within high-risk multidrug-resistant bacterial clones. These combined pathways enable the bacteria to persist across both healthcare and community environments. Furthermore, certain variants such as OXA-244 and OXA-484 are challenging to detect with standard laboratory diagnostics, leading to silent transmission and probable underreporting in hospitals and wider communities.
Carbapenems are critical antibiotics used to treat severe bacterial infections. The silent spread of resistant bacteria that evade routine laboratory detection threatens standard treatment protocols in both hospitals and communities. Understanding how these resistance genes spread helps public health authorities and diagnostic laboratories identify blind spots, strengthen surveillance, and prevent untreatable bacterial outbreaks.
The abstract outlines diagnostic and epidemiological challenges but does not indicate an application pathway or specific technology ready for commercialisation.
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<i>Enterobacterales</i> (mostly <i>Klebsiella pneumoniae</i>, <i>Escherichia coli</i>) with OXA-48-like carbapenemases (e.g., OXA-48, -181, -232, -244) are undermining the global efficiency of carbapenem therapy. In the Middle East, North Africa, and some European countries, OXA-48-like carbapenemases are the most common types of carbapenemases among <i>Enterobacterales</i>. Currently, OXA-48 is endemic in the Middle East, North Africa, Spain, France, and Belgium; OXA-181 is endemic in Sub-Saharan Africa and the Indian Subcontinent, while OXA-232 has been increasing in the Indian Subcontinent. European countries (e.g., Germany, Denmark, Switzerland, France) are experiencing community outbreaks with <i>E. coli</i> ST38 that produce OXA-244, and these strains have been introduced into Norwegian, Polish, and Czech hospitals. The global ascendancy of OXA-48-like genes is due to the combination of carbapenemases with horizontal spread through promiscuous plasmids (e.g., IncL, IncX3, ColE2) and vertical spread with certain high-risk multidrug-resistant clones (e.g., <i>K. pneumoniae</i> ST14, ST15, ST147, ST307; <i>E. coli</i> ST38, ST410). This is a powerful "gene survival strategy" that has assisted with the survival of OXA-48-like genes in different environments including the community setting. The laboratory diagnosis is complex; therefore, bacteria with "difficult to detect" variants (e.g., OXA-244, OXA-484) are likely underreported and are spreading silently "beneath the radar" in hospital and community settings. <i>K. pneumoniae</i> and <i>E. coli</i> with OXA-48-like carbapenemases are forces to be reckoned with.
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DOI: 10.1128/jcm.01515-24
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