The rapid increase of OXA-244-producing , predominantly driven by genetically clustered isolates of sequence type (ST)38, has been observed in at least nine European countries, including Germany. However, the reasons for the spread of OXA-244-producing remain unclear. Here, we aim to evaluate the possibility of prolonged carriage. We identified a total of six different patients with repeated detection of OXA-244-producing isolates, which were subjected to both short and long-read whole-genome sequencing (WGS). Besides allelic differences using core genome multilocus sequence typing (cgMLST) analyses, we obtained numbers of single-nucleotide polymorphisms (SNPs) to calculate individual base-pair substitution (BPS) rates. To assess possible re-exposure and risk factors for prolonged carriage, case interviews were conducted. The time between detections ranged from eleven months to more than three years. Initial isolates originated in three+ out of six cases from clinical samples, whereas remaining samples were from screening, mostly in the inpatient setting. As expected, cgMLST analyses showed low numbers of allelic differences between isolates of each case ranging from 1 to 4, whereas numbers of SNPs were between 2 and 99 (mean = 36), thus clearly highlighting the discrepancy between these different bacterial typing approaches. For five out of six cases, observed BPS rates suggest that patients can be colonized with OXA-244-producing , including ST38 cluster isolates, for extensively long times. Thus, we may have previously missed the epidemiological link between cases because exposure to OXA-244-producing could have occurred in a time frame, which has not been evaluated in previous investigations. Our results may help to guide future epidemiological investigations as well as to support the interpretation of genetic diversity of OXA-244-producing , particularly among ST38 cluster isolates.

中文翻译：

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产生 OXA-244-碳青霉烯酶的大肠杆菌的长期携带使流行病学调查变得复杂

产生 OXA-244 的快速增加主要是由序列类型 (ST)38 的基因聚集分离株驱动的，在包括德国在内的至少 9 个欧洲国家已观察到。然而，产生 OXA-244 的扩散的原因仍不清楚。在这里，我们的目的是评估长时间运输的可能性。我们确定了总共 6 名不同的患者，这些患者重复检测到产生 OXA-244 的分离株，并对这些患者进行了短读长和长读长全基因组测序 (WGS)。除了使用核心基因组多位点序列分型 (cgMLST) 分析的等位基因差异之外，我们还获得了单核苷酸多态性 (SNP) 的数量来计算个体碱基对替换 (BPS) 率。为了评估可能的再次暴露和长期携带的风险因素，进行了病例访谈。检测间隔时间从十一个月到三年多不等。最初的分离株来自六分之三以上的临床样本，而其余样本来自筛查，大部分来自住院患者。正如预期的那样，cgMLST 分析显示每个病例的分离株之间的等位基因差异数量较少，范围为 1 至 4 个，而 SNP 数量在 2 至 99 之间（平均值 = 36），从而清楚地突出了这些不同细菌分型方法之间的差异。对于六分之五的病例，观察到的 BPS 率表明患者可能会被产生 OXA-244 的细菌（包括 ST38 簇分离株）定植很长一段时间。因此，我们之前可能错过了病例之间的流行病学联系，因为接触 OXA-244 产生物可能是在某个时间范围内发生的，而这一时间范围在之前的调查中尚未得到评估。我们的结果可能有助于指导未来的流行病学调查，并支持对产生 OXA-244 的遗传多样性的解释，特别是在 ST38 簇分离株中。