Division of Microbiology, Alberta Public Laboratories, Edmonton, Alberta, Canada
Department of Pathology & Laboratory Medicine, University of Calgary, Cummings School of Medicine, Calgary, Alberta, Canada.
Clin Microbiol Rev. 2019 Nov 13;33(1). doi: 10.1128/CMR.00102-19. Print 2019 Dec 18.
Surveillance studies have shown that OXA-48-like carbapenemases are the most common carbapenemases in 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 Tn 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 IS, Tn 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., sequence type 147 [ST147], ST307, ST15, and ST14 and ST38 and ST410) have been associated with the global dispersion of OXA-48, OXA-181, OXA-232, and OXA-204. Chromosomal integration of within Tn occurred among ST38 isolates, especially in the United Kingdom. The detection of 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 and ) with , , and 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.
监测研究表明，OXA-48 类碳青霉烯酶是世界某些地区最常见的碳青霉烯酶，并且正在定期引入非流行地区，在这些地区，它们是导致医院感染爆发的原因。OXA-48、OXA-181、OXA-232、OXA-204、OXA-162 和 OXA-244 是 OXA-48 类碳青霉烯酶组中最常见的酶。OXA-48 与 IncL 质粒上的不同 Tn 变体有关，在北非和中东流行。OXA-162 和 OXA-244 是 OXA-48 的衍生物，存在于欧洲。OXA-181 和 OXA-232 与 IS、Tn 在 ColE2 上和 IncX3 类型的质粒有关，在印度次大陆（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流行。总体而言，克隆传播在 OXA-48 类碳青霉烯酶的传播中作用较小，但某些高风险克隆（如序列型 147 [ST147]、ST307、ST15 和 ST14 以及 ST38 和 ST410）与 OXA-48、OXA-181、OXA-232 和 OXA-204 的全球传播有关。Tn 内 的染色体整合发生在 ST38 分离株中，尤其是在英国。使用表型方法检测到带有 OXA-48 类酶的 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。鉴定 OXA-48 类酶的特定类型需要相应基因的测序。具有 、 和 的细菌（尤其是 和 ）正在世界不同地区出现，由于这些酶的实验室检测存在问题，它们很可能被低估。医学界应该意识到带有 OXA-48 类碳青霉烯酶的细菌所构成的迫在眉睫的威胁。
