# Emergence of OXA-48-like Carbapenemase-Producing Escherichia coli in Baranya County, Hungary

## TL;DR

This study tracks the emergence of antibiotic-resistant E. coli in Hungary, highlighting the spread of OXA-48-like carbapenemase producers and their genetic characteristics.

## Contribution

The study reports the first detection of OXA-48-like carbapenemase-producing E. coli in Hungary and identifies unique plasmid associations.

## Key findings

- Six OXA-48-like carbapenemase-producing E. coli isolates were identified among 6722 samples in Hungary.
- blaOXA-181 was found on a non-conjugative IncFIB-IncFIC plasmid, previously only reported in Ghana.
- E. coli ST38 isolates were closely related to European and Qatari strains and carried blaCTX-M-27.

## Abstract

Background: Carbapenem-resistant Escherichia coli (CREC) producing OXA-48-like carbapenemase was first detected in Hungary in 2022. The aim of the present study was to characterize such strains isolated in 2022–2025 in Baranya County, Hungary. Methods: Antibiotic susceptibility and the whole-genome sequence (WGS) of E. coli isolates, identified as OXA-48-like carbapenemase producers using the CARBA-5 NG test, were established. The transferability of blaOXA-48-like plasmids was tested by conjugation. Results: Of the 6722 non-repeat E. coli isolates, 6 produced an OXA-48-like carbapenemase. They exhibited variable resistance to ertapenem and were susceptible to imipenem and meropenem. WGS revealed that all OXA-48-like producer E. coli belonged to high-risk clones: two clonally related OXA-181-producer E. coli ST405 were isolated in Hospital A, three OXA-244-producing E. coli ST38 (two identical via cgMLST from Hospital B), and an OXA-48-producing E. coli ST69. The blaOXA-48 and blaOXA-244 genes were chromosomally located, while blaOXA-181 was on a non-conjugative IncFIB-IncFIC plasmid. So far, the blaOXA-181-bearing plasmid of this incompatibility type has only been described in Ghana, but all blaOXA-48-like gene-carrying transposons in this study have already been identified in Europe and other continents. The E. coli ST38 isolates, showing close association based on core genome SNP distances to European and Qatari strains, belonged to Cluster A and harbored blaCTX-M-27. All but the E. coli ST69 isolate had cephalosporinase gene(s). Conclusions: This study describes small-scale intra-hospital transfers of OXA-48-like carbapenemase-producer E. coli. Interestingly, E. coli ST405 of Hungary carried blaOXA-181 on an IncFIB-IncFIC plasmid, which has only been reported from Africa so far.