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stay, Patient A received successively piperacillin/tazobactam with vancomycin, cefepime with ciprofloxacin, and imipenem with ciprofloxacin, but Patient B only received amoxicillin/clavulanate (Figure 1). It is well established that K. pneumoniae isolates are an important reservoir of b-lactamases. Thus, the dissemination of the KPC carbapenemase has been linked to the dispersion of a clonal ST258-type K. pneumoniae strain. Nevertheless, it appears that the rapid emergence of blaOXA-48 in K. pneumoniae would be explained by the horizontal transmission of an OXA-48-encoding plasmid within strains belonging to different STs. Our experience raises concern about a possible rapid rise in carbapenem resistance in enteric bacteria through the spread of blaOXA-48-positive plasmids and/or strains. Outbreaks involving different OXA-48-producing species have already been described. Early detection by sensitive screening methods is needed, with targeted surveillance and consideration given to infection control measures, to prevent this spread.

Emergence of metallo- -lactamases GIM-1 and VIM in multidrug-resistant Pseudomonas aeruginosa in North Rhine-Westphalia, Germany