international Epidemiology of Carbapenemase-Producing Escherichia Coli

Authors

Angelique E Boutzoukas
Lauren Komarow
Liang Chen
Blake Hanson
Souha S Kanj
Zhengyin Liu
Soraya Salcedo Mendoza
Karen Ordoñez
Minggui Wang
David L Paterson
Scott Evans
Lizhao Ge
Abhigya Giri
Carol Hill
Keri Baum
Robert A Bonomo
Barry Kreiswirth
Robin Patel
Cesar A Arias
Henry F Chambers
Vance G Fowler
David van Duin

Publication Date

8-22-2023

Journal

Clinical Infectious Diseases

Abstract

BACKGROUND: Carbapenemase-producing (CP) Escherichia coli (CP-Ec) are a global public health threat. We aimed to describe the clinical and molecular epidemiology and outcomes of patients from several countries with CP-Ec isolates obtained from a prospective cohort.

METHODS: Patients with CP-Ec were enrolled from 26 hospitals in 6 countries. Clinical data were collected, and isolates underwent whole-genome sequencing. Clinical and molecular features and outcomes associated with isolates with or without metallo-β-lactamases (MBLs) were compared. The primary outcome was desirability of outcome ranking (DOOR) at 30 days after the index culture.

RESULTS: Of the 114 CP-Ec isolates in Consortium on resistance against carbapenems in Klebsiella and other Enterobacterales-2 (CRACKLE-2), 49 harbored an MBL, most commonly blaNDM-5 (38/49, 78%). Strong regional variations were noted with MBL-Ec predominantly found among patients in China (23/49). Clinically, MBL-Ec were more often from urine sources (49% vs 29%), less often met criteria for infection (39% vs 58%, P = .04), and had lower acuity of illness when compared with non-MBL-Ec. Among patients with infection, the probability of a better DOOR outcome for a randomly selected patient with MBL-Ec as compared with non-MBL-Ec was 62% (95% CI: 48.2-74.3%). Among infected patients, non-MBL-Ec had increased 30-day (26% vs 0%; P = .02) and 90-day (39% vs 0%; P = .001) mortality compared with MBL-Ec.

CONCLUSIONS: Emergence of CP-Ec was observed with important geographic variations. Bacterial characteristics, clinical presentations, and outcomes differed between MBL-Ec and non-MBL-Ec. Mortality was higher among non-MBL isolates, which were more frequently isolated from blood, but these findings may be confounded by regional variations.

Keywords

Humans, Prospective Studies, beta-Lactamases, Escherichia coli, Bacterial Proteins, Carbapenem-Resistant Enterobacteriaceae, Anti-Bacterial Agents, Microbial Sensitivity Tests