# Circulation of polyclonal OXA-244-producing Escherichia coli lineages in Jerusalem, Israel

## TL;DR

This study shows that OXA-244-producing E. coli is common in a Jerusalem hospital and suggests it spreads widely in the community.

## Contribution

The study reveals the high prevalence and genetic diversity of OXA-244-producing E. coli in Israel.

## Key findings

- OXA-244 was the most common carbapenemase among OXA-48-like-producing E. coli isolates.
- Most OXA-244 cases were healthcare-associated, but community transmission was also observed.
- blaOXA-244 was chromosomally located in transposon Tn51098 variants across diverse clones.

## Abstract

OXA-244-producing Escherichia coli represents an emerging concern in Europe due to its rapid spread and difficult-to-detect phenotype. While other OXA-48-like carbapenemases emerged in Israel in 2007, the circulation of OXA-244-producing E. coli was only recently reported. We aimed to investigate the proportion of OXA-244 amongst OXA-48-like-producing E. coli in a tertiary care university hospital in Jerusalem, Israel, during 2024. We analysed their mode of acquisition, phylogeny, resistome, and the genetic context of blaOXA-244 in these isolates.

In 2024, 171 patients were identified with OXA-48-like-producing E. coli from screening or clinical samples. Of these, 53 were selected using convenience sampling across the entire year for whole genome characterization using short-read sequencing and a subset also underwent long-read sequencing.

Amongst the 53 sequenced OXA-48-like-producing E. coli, the majority harboured blaOXA-244 (n = 34), followed by blaOXA-48 (n = 11), and blaOXA-181 (n = 8). Of the 34 OXA-244-producing E. coli, transmission was classified as probably or possibly healthcare-associated for 88.2%, and community-acquired for 11.8%. The OXA-244-producing E. coli isolates belonged to 13 distinct STs that mainly matched internationally described clones. Core genome MLST demonstrated seven genomic clusters (≤10 allele differences), indicating close common ancestry. Long-read sequencing demonstrated that blaOXA-244 was chromosomally located within variants of the transposon Tn51098 across STs.

This study demonstrates the predominance of OXA-244-producing E. coli in a tertiary care hospital in Jerusalem, Israel among OXA-48-like-producing isolates. The clonal diversity points to ongoing unrecognized community transmission, necessitating targeted surveillance and control measures.