Escherichia coli strain:Co6114 Genome sequencing. Escherichia coli strain:Co6114

We report the first E. coli strain co-producing the two carbapenemases blaNDM-1 and blaOXA-232. While endemic in Greece and India, double-carbapenemase producing enterobacteria are still rare in Germany. The dissemination of these pathogens is worrisome as it potentially further narrows the therapeutic options. Carbapenemase positive strains often display only moderately elevated MICs for at least one carbapenem and high-dose carbapenem therapy with prolonged infusion may be used for treatment in those instances. Double-carbapenemase production likely compromises this therapeutic option. Furthermore, newly developed beta-lactamase inhibitors with activity towards carbapenemases have recently been approved by several drug agencies and hold great promise for currently difficult or even untreatable infections. The presence of diverse beta-lactamases from different molecular groups in one pathogen may result in only partial inhibition and consequently in therapeutic failure. The isolation of nearly identical blaOXA-232 carrying plasmids from geographically and temporally unrelated cases not only from K. pneumoniae but now also from E. coli suggests high mobility of the plasmid, which may be more widespread than currently appreciated. Taken together, we characterized the first blaNDM-1/blaOXA-232 double-carbapenemase producing E. coli, highlighting the constant emergence of novel, highly drug resistant pathogens in central Europe and the necessity to control their spread.