ABSTRACT We describe a 16-year-old neutropenic patient from the Middle East with bloodstream infection caused by two carbapenemase-producing Escherichia coli isolates that we characterized by whole-genome sequencing. While one displayed meropenem resistance and was bla _NDM positive, the other demonstrated meropenem susceptibility yet harbored bla _OXA181 (which encodes a bla _OXA48 -like enzyme). This report highlights the challenge of laboratory detection of bla _OXA48 -like enzymes and the clinical implications of genotypic resistance detection in carbapenemase-producing Enterobacteriaceae .