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The aim of the study was to analyse the epidemiology and the mechanisms of antibiotic resistance of OXA-48 carbapenemase producing <jats:italic>K. pneumoniae<\/jats:italic> strains isolated from urine of non-hospitalized elderly patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The isolates were classified into two groups: one originated from the LTCFs and the other from the community. Extended-spectrum \u03b2-lactamases (ESBLs) were detected by double disk-synergy (DDST) and combined disk tests in 55% of the isolates (51\/92). The ESBL-positive isolates exhibited resistance to expanded-spectrum cephalosporins (ESC) and in majority of cases to gentamicin. LTCFs isolates showed a significantly lower rate of additional ESBLs and consequential resistance to ESC and a lower gentamicin resistance rate compared to the community isolates, similarly to hospital isolates in Zagreb, pointing out to the possible transmission from hospitals.ESBL production was associated with group 1 of CTX-M or SHV-12 \u03b2-lactamases. Ertapenem resistance was transferable from only 12 isolates. <jats:italic>bla<\/jats:italic><jats:sub>OXA-48<\/jats:sub> genes were carried by IncL plasmid in 42 isolates. In addition IncFII and IncFIB were identified in 18 and 2 isolates, respectively. Two new sequence types were reported: ST4870 and ST4781.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This study showed eruptive and extensive diffusion of OXA-48 carbapenemase to LTCFs and community population in Zagreb County, particularly affecting patients with UTIs and urinary catheters. On the basis of susceptibility testing, \u03b2-lactamase production, conjugation experiments, MLST and plasmid characterization it can be concluded that there was horizontal gene transfer between unrelated isolates, responsible for epidemic spread of OXA-48 carbapenemase in the LTCFs and the community The rapid spread of OXA-48 producing <jats:italic>K. pneumoniae<\/jats:italic> points out to the shortcomings in the infection control measures.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12866-022-02443-y","type":"journal-article","created":{"date-parts":[[2022,1,19]],"date-time":"2022-01-19T08:03:43Z","timestamp":1642579423000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Diffusion of OXA-48 carbapenemase among urinary isolates of Klebsiella pneumoniae in non-hospitalized elderly patients"],"prefix":"10.1186","volume":"22","author":[{"given":"Sandra","family":"\u0160uto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branka","family":"Bedeni\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sa\u0161a","family":"Liki\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Kibel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Anu\u0161i\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimira","family":"Ti\u010di\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gernot","family":"Zarfel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Grisold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Bari\u0161i\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmina","family":"Vrane\u0161","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,19]]},"reference":[{"key":"2443_CR1","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1111\/j.1469-0691.2012.03815.x","volume":"8","author":"R Cant\u00f3n","year":"2012","unstructured":"Cant\u00f3n R, Ak\u00f3va M, Carmeli Y, Giske CG, Glupczynski Y, et al. 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According to the rules of the Institutional Review Board (Ethical Committee) of the \u201cDr. Andrija Stampar\u201d Teaching Institute of Public Health it is not necessary to obtain an informed consent for the analysis of the isolates from the Institute anonimysed collections of multidrug-resistant strains. All multidrug-resistant isolates are stored in glycerol tubes at -80\u00ba C and it is possible to use them later for research purposes, according to procedure for multi-drug resistant bacteria required by Croatian National Reference Center for Surveillance of Bacterial Resistance. Ethical Permission for this study was issued by Ethical Committee of \u201cDr. Andrija Stampar\u201d Teaching Institute of Public Health (Classification number of permission is 641\u201301\/20\u201301\/01; registry number is 381\u201321-29).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"None to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"30"}}