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Our study highlights that this SXT/R391 ICE may facilitate the dissemination of clinically important resistance genes such as blaNDM-1, cfr and aac(6'-lb-cr. © The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email [email protected] Beta-lactam antibiotics are first line therapy for perioperative prophylaxis; however, patient-reported allergies often lead to increased prescribing of alternative a