Population-Based Study of Emergence and Spread of–<i>Escherichia coli</i> Producing OXA-48–Like Carbapenemases, Israel, 2007–2023

Escherichia coli producing OXA-48-like carbapenemases (OXA-EC) is considered a high-risk pathogen spread primarily in the community in low- and middle-income countries and nosocomially in high-income countries. We investigated the emergence and spread of OXA-EC in Israel, a high-income country with strong carbapenemase-directed infection control in healthcare institutions, by conducting a population-based study using data and isolates from the national surveillance system. A total of 3,510 incident cases of OXA-EC occurred during 2007-2023. During 2016-2023, annual cases rose from 41 to 1,524 and nonnosocomial cases rose from 39% to 57%. Sixty-three sequenced isolates belonged to 20 sequence types (STs) and had 3 bla_OXA alleles (bla_OXA-244, bla_OXA-48, and bla_OXA-181); 71% were chromosomally encoded, and 29% were plasmid-encoded. Nosocomially and non-nosocomially acquired isolates belonged to the same STs and alleles. Most outbreaks involved multiple STs and could only partially be explained by plasmid dissemination. Measures for confronting OXA-EC might need reconsideration.