, Volume 44, Issue 1, pp 107–110 | Cite as

Retrospective identification of a previously undetected clinical case of OXA-48-producing K. pneumoniae and E. coli: the importance of adequate detection guidelines

  • Ina Willemsen
  • Joost van Esser
  • Marjolein Kluytmans-van den Bergh
  • Kai Zhou
  • John W. Rossen
  • Carlo Verhulst
  • Kees Verduin
  • Jan Kluytmans
Case Report



The laboratory detection of OXA-48-carbapenemase-producing Enterobacteriaceae is difficult, as minimum inhibition concentrations for carbapenems are often below the clinical breakpoint. In 2011, the Dutch national guideline for the detection of highly resistant micro-organisms was issued, which includes recommendations on the use of carbapenem screening breakpoints for the detection of carbapenemase-producing Enterobacteriaceae.

Materials and Methods

During a validation study of the Check-MDR CT103 microarray (Check-Points, Wageningen, The Netherlands) in 2013, an OXA-48-like carbapenemase gen was identified in two isolates that were previously obtained from a patient with non-Hodgkin lymphoma in 2007. Whole-genome sequencing (WGS) and subsequent BLAST Ringe Image Generator (BRIG) analysis were performed to establish the presence of OXA-48 carbapenemase encoding plasmids and their similarity.


This case report describes the first documented OXA-48-producing Klebsiella pneumonia (ST648) and Escherichia coli (ST866) in the Netherlands. A similar IncL/M plasmid was identified in both strains, suggesting within-patient horizontal transfer.


This case illustrates that OXA-48-carbapenemase-producing Enterobacteriaceae can be unnoticed without adequate laboratory detection procedures. Our observation stresses the importance of uniform and adequate laboratory methods for the timely and accurate detection of important antimicrobial resistance.


OXA-48 β-lactamase Antimicrobial resistance Plasmid transfer Detection guidelines 


Conflict of interest

All authors report no conflicts of interest relevant to this article.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ina Willemsen
    • 1
  • Joost van Esser
    • 2
  • Marjolein Kluytmans-van den Bergh
    • 3
    • 4
  • Kai Zhou
    • 5
  • John W. Rossen
    • 5
  • Carlo Verhulst
    • 1
  • Kees Verduin
    • 1
  • Jan Kluytmans
    • 1
    • 4
  1. 1.Laboratory for Microbiology and Infection ControlAmphia HospitalBredaThe Netherlands
  2. 2.Department for internal medicineAmphia HospitalBredaThe Netherlands
  3. 3.Amphia Academy Infectious Disease FoundationAmphia HospitalBredaThe Netherlands
  4. 4.Julius Center for Health Sciences and Primary CareUMC UtrechtUtrechtThe Netherlands
  5. 5.Department of Medical Microbiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands

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