Short Communication For reprint orders, please contact: reprints@futuremedicine.com Increase and diversity of carbapenemase-producing Escherichia coli isolates, Italy Serena Simoni 1 , Sara Caucci 1 , Andrea Brenciani 1 , Gianluca Morroni 1 , Eleonora Giovanetti 2 , Stefano Menzo 1 , Bruna Facinelli 1 & Marina Mingoia* ,1 1 Unit of Microbiology, Department of Biomedical Sciences & Public Health Polytechnic University of Marche Medical School, Ancona, Italy 2 Unit of Microbiology, Department of Life & Environmental Sciences Polytechnic University of Marche, Ancona, Italy *Author for correspondence: Tel.: +39 071 220 6295; Fax: +39 071 220 6293; m.mingoia@staff.univpm.it Aim: This study reports on a surveillance in an Italian hospital focused on carbapenemase-producing Escherichia coli (CP-Ec). Materials & methods: Eighteen isolates (nine from clinical specimens and nine from rectal swab) were characterized for antibiotic susceptibilities, typing features, main carbapenemase, extended-spectrum ß-lactamases (ESBLs) and other bla genes, and their transferability by conjugation and transformation. Results: An increase in CP-Ec isolates was observed during 3-year surveillance period. Compared with the clinical isolates, all belonging to one sequence type (ST), ST131, those from rectal swab were very heterogeneous and belonged to eight STs. Transfer data confrmed the role of conjuga- tive plasmids in the spreading of carbapenemase genes. Conclusion: The prevalence of CP-Ec in Italy has risen, with a substantial increase over the last year. First draft submitted: 7 March 2019; Accepted for publication: 26 June 2019; Published online: 30 August 2019 Keywords: β-lactamases • carbapenemases • coproduction of VIM-1 and KPC-2 • Escherichia coli • VIM, KPC and OXA-48 types Infections due to carbapenemase-producing Enterobacteriaceae (CPE) currently represent one of the most important public health challenges. Indeed, in a recent document on the global priority list of antibiotic-resistant bacteria, the WHO has described CPE as one of the most urgent antimicrobial-resistance threats [1]. The worldwide successful rise of CPE has been attributed to different factors [2], the most significant being the location of the relevant genes on conjugative plasmids and their rapid spread in enterobacteria in several reservoirs. The dissemination of CPE occurs mainly in medical institutions but has also been reported in the community [3]. Different types of acquired carbapenemases, with significant geographic variability, are detected in Enterobacteri- aceae [4]. Carbapenemases belong to three Ambler classes: class A, where KPC is the most widespread and clinically relevant type; class B, including metallo-β-lactamases VIM, IMP and NDM; and class D, including OXA-48-like enzymes (with the OXA-48 and OXA-181 variants being predominant) [5]. Italy is among the European countries where an endemic prevalence of CPE is more pronounced [4,6], mostly due to the dissemination of international clones of Klebsiella pneumoniae (e.g., CC258) in the hospital setting. However, the emergence of carbapenemase production may be an even greater matter of concern toward Escherichia coli, which not only is the second species in terms of isolation frequency among CPE [4], but unlike K. pneumoniae – that is a primarily nosocomial pathogen – is responsible for both community- and hospital-acquired infections and may thus be even more troubling in perspective. This study reports the results of the epidemiological survey and characterization of carbapenemase-producing E. coli (CP-Ec) isolates recovered in an Italian regional hospital over the past 3 years from patients with invasive and noninvasive infections or subjected to rectal screening as standard of care for infection control of CPE. Future Microbiol. (2019) 14(12), 1035–1042 ISSN 1746-0913 1035 10.2217/fmb-2019-0069 C  2019 Future Medicine Ltd