Peirano, GiselePitout, Johann D.D.2025-11-072025-11-072025-02Peirano, G. & Pitout, J.D.D. 2025, 'Rapidly spreading Enterobacterales with OXA-48-like carbapenemases', Journal of Clinical Microbiology, vol. 63, no. 2, pp. 1-15, doi : 10.1128/jcm.01515-24.0095-1137 (print)1098-660X (online)10.1128/jcm.01515-24http://hdl.handle.net/2263/105159Part of this work was presented as an oral presentation at the pre-ECCMID Day on AMR—old problems and new challenges in March 2023.Enterobacterales (mostly Klebsiella pneumoniae, Escherichia coli) with OXA-48-like carbapenemases (e.g., OXA-48, -181, -232, -244) are undermining the global efficiency of carbapenem therapy. In the Middle East, North Africa, and some European countries, OXA-48-like carbapenemases are the most common types of carbapenemases among Enterobacterales. Currently, OXA-48 is endemic in the Middle East, North Africa, Spain, France, and Belgium; OXA-181 is endemic in Sub-Saharan Africa and the Indian Subcontinent, while OXA-232 has been increasing in the Indian Subcontinent. European countries (e.g., Germany, Denmark, Switzerland, France) are experiencing community outbreaks with E. coli ST38 that produce OXA-244, and these strains have been introduced into Norwegian, Polish, and Czech hospitals. The global ascendancy of OXA-48-like genes is due to the combination of carbapenemases with horizontal spread through promiscuous plasmids (e.g., IncL, IncX3, ColE2) and vertical spread with certain high-risk multidrug-resistant clones (e.g., K. pneumoniae ST14, ST15, ST147, ST307; E. coli ST38, ST410). This is a powerful “gene survival strategy” that has assisted with the survival of OXA-48-like genes in different environments including the community setting. The laboratory diagnosis is complex; therefore, bacteria with “difficult to detect” variants (e.g., OXA-244, OXA-484) are likely underreported and are spreading silently “beneath the radar” in hospital and community settings. K. pneumoniae and E. coli with OXA-48-like carbapenemases are forces to be reckoned with.en© 2025 Peirano and Pitout. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.CarbapenemasesEpidemiologyLaboratory detectionOXA-48-likeArticle