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Hospital outbreak of carbapenem-resistant Enterobacteriales associated with an OXA-48 plasmid carried mostly by Escherichia coli ST399

By Alice Ledda, Martina Cummins, Liam P. Shaw, Elita Jauneikaite, Kevin Cole, Florent Lasalle, Deborah Barry, Caryn Rosmarin, Sudy Anaraki, David Wareham, Nicole Stoesser, John Paul, Rohini Manuel, Benny P Cherian, Xavier Didelot

Posted 15 Jun 2020
bioRxiv DOI: 10.1101/2020.06.15.148189

A hospital outbreak of carbapenem-resistant Enterobacteriales was detected by routine surveillance. Whole genome sequencing and subsequent analysis revealed a conserved promiscuous OXA-48 carrying plasmid as the defining factor within this outbreak. Four different species of Enterobacteriales were involved in the outbreak. Escherichia coli ST399 accounted for 20/55 of all the isolates. Comparative genomics with publicly available E. coli ST399 sequence data showed that the outbreak isolates formed a unique clade. The OXA-48 plasmid identified in the outbreak differed from other known plasmids by an estimated five homologous recombination events. We estimated a lower bound to the plasmid conjugation rate to be 0.23 conjugation events per lineage per year. Our analysis suggests co-evolution between the plasmid and its main bacterial host to be a key driver of the outbreak. This is the first study to report carbapenem-resistant E. coli ST399 carrying OXA48 as the main cause of a plasmid-borne outbreak within a hospital setting. This study supports complementary roles for both plasmid conjugation and clonal expansion in the emergence of this outbreak. ### Competing Interest Statement The authors have declared no competing interest.

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