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

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