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The aim was to explore the transmission of OXA-48-producing strains between infants and the transfer of resistance plasmids between strains during the outbreak. Twenty-four outbreak isolates from ten suspected cases were whole-genome sequenced. A complete assembly was created for the index isolate (\n                    <jats:italic>Enterobacter cloacae<\/jats:italic>\n                    ) and used as a mapping reference to detect its plasmids in the remaining isolates (17\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    , 4\n                    <jats:italic>Klebsiella aerogenes<\/jats:italic>\n                    , and 2\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    ). Strain typing was performed using core genome MLST and SNP analysis. As judged from sequencing and clinical epidemiological data, the outbreak involved nine cases (two developed sepsis) and four OXA-48-producing strains:\n                    <jats:italic>E. cloacae<\/jats:italic>\n                    ST1584 (index case),\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    ST25 (eight cases),\n                    <jats:italic>K. aerogenes<\/jats:italic>\n                    ST93 (two cases), and\n                    <jats:italic>E. coli<\/jats:italic>\n                    ST453 (2 cases). Two plasmids from the index strain, p\n                    <jats:italic>Ecl<\/jats:italic>\n                    A2 and p\n                    <jats:italic>Ecl<\/jats:italic>\n                    A4, carrying\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA48<\/jats:sub>\n                    and\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CMY-4<\/jats:sub>\n                    , respectively, were traced to all\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    ST25 isolates.\n                    <jats:italic>Klebsiella aerogenes<\/jats:italic>\n                    ST93 and\n                    <jats:italic>E. coli<\/jats:italic>\n                    ST453 harboured either only p\n                    <jats:italic>Ecl<\/jats:italic>\n                    A2, or both p\n                    <jats:italic>Ecl<\/jats:italic>\n                    A2 and p\n                    <jats:italic>Ecl<\/jats:italic>\n                    A4. One suspected case harbouring OXA-162-producing\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    ST37 could be excluded from the outbreak. Once initiated by an\n                    <jats:italic>E. cloacae<\/jats:italic>\n                    strain, the outbreak was caused by the dissemination of a\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    ST25 strain and involved inter-species horizontal transfer of two resistance plasmids, one of which carried\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-48<\/jats:sub>\n                    . To our knowledge, this is the first description of an outbreak of OXA-48-producing\n                    <jats:italic>Enterobacteriaceae<\/jats:italic>\n                    in a neonatal setting in northern Europe.\n                  <\/jats:p>","DOI":"10.1007\/s10096-023-04584-y","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T03:02:55Z","timestamp":1679281375000},"page":"597-605","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Outbreak of OXA-48-producing Enterobacteriaceae in a neonatal intensive care unit in Western Sweden"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0787-8786","authenticated-orcid":false,"given":"Erika T\u00e5ng","family":"Hallb\u00e4ck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Johnning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Myhrman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Studahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabet","family":"Hentz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Elfvin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingegerd","family":"Adlerberth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,3,20]]},"reference":[{"key":"4584_CR1","unstructured":"Institute PHAoSaNV, Swedres Svarm- sales of antibiotics and occurrence of antibiotic resistance in Sweden, in Swedres Svarm, R.O.a.W.T. 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