Surveillance studies have shown that OXA-48-like carbapenemases are the most common carbapenemases in Enterobacterales in certain regions of the world and are being introduced on a regular basis into regions of nonendemicity, where they are responsible for nosocomial outbreaks. OXA-48, OXA-181, OXA-232, OXA-204, OXA-162, and OXA-244, in that order, are the most common enzymes identified among the OXA-48-like carbapenemase group. OXA-48 is associated with different Tn1999 variants on IncL plasmids and is endemic in North Africa and the Middle East. OXA-162 and OXA-244 are derivatives of OXA-48 and are present in Europe. OXA-181 and OXA-232 are associated with ISEcp1, Tn2013 on ColE2, and IncX3 types of plasmids and are endemic in the Indian subcontinent (e.g., India, Bangladesh, Pakistan, and Sri Lanka) and certain sub-Saharan African countries. Overall, clonal dissemination plays a minor role in the spread of OXA-48-like carbapenemases, but certain high-risk clones (e.g., Klebsiella pneumoniae sequence type 147 [ST147], ST307, ST15, and ST14 and Escherichia coli ST38 and ST410) have been associated with the global dispersion of OXA-48, OXA-181, OXA-232, and OXA-204. Chromosomal integration of bla OXA-48 within Tn6237 occurred among E. coli ST38 isolates, especially in the United Kingdom. The detection of Enterobacterales with OXA-48-like enzymes using phenotypic methods has improved recently but remains challenging for clinical laboratories in regions of nonendemicity. Identification of the specific type of OXA-48-like enzyme requires sequencing of the corresponding genes. Bacteria (especially K. pneumoniae and E. coli) with bla OXA-48, bla OXA-181, and bla OXA-232 are emerging in different parts of the world and are most likely underreported due to problems with the laboratory detection of these enzymes. The medical community should be aware of the looming threat that is posed by bacteria with OXA-48-like carbapenemases.

中文翻译：

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OXA-48型碳青霉烯酶的全球上升。

监测研究表明，OXA-48样碳青霉烯酶是世界上某些地区肠杆菌中最常见的碳青霉烯酶，并定期引入非传染性地区，这些地区是造成医院内暴发的原因。OXA-48，OXA-181，OXA-232，OXA-204，OXA-162和OXA-244依次是OXA-48-样碳青霉烯酶组中最常见的酶。OXA-48与IncL质粒上的不同Tn1999变体相关，在北非和中东地区很流行。OXA-162和OXA-244是OXA-48的衍生物，在欧洲存在。OXA-181和OXA-232与ISEcp1，Tn2013的ColE2和IncX3类型的质粒相关，并在印度次大陆（例如印度，孟加拉国，巴基斯坦和斯里兰卡）和某些撒哈拉以南非洲国家中流行。总体而言，克隆传播在类似OXA-48的碳青霉烯酶的传播中起较小的作用，但在某些高风险克隆中（例如肺炎克雷伯菌序列类型147 [ST147]，ST307，ST15和ST14，以及大肠杆菌ST38和ST410）与OXA-48，OXA-181，OXA-232和OXA-204的全球散布有关。bla OXA-48在Tn6237中的染色体整合发生在大肠杆菌ST38分离株中，尤其是在英国。使用表型方法用OXA-48样酶对肠杆菌的检测最近有所改善，但对于非流行地区的临床实验室仍然具有挑战性。特定类型的OXA-48样酶的鉴定需要对相应基因进行测序。细菌（尤其是肺炎克雷伯氏菌和大肠杆菌）与bla OXA-48，bla OXA-181，bla和OXA-232和bla OXA-232在世界各地出现，由于实验室检测这些酶存在问题，因此极有可能被低估。医学界应意识到类似OXA-48的碳青霉烯酶的细菌所带来的迫在眉睫的威胁。