Citations 2
Escherichia coli ST131 Drives Carbapenem Use for E. coli Bloodstream Infections
Mackow, Natalie , Shao, Wanying, Ge, Lizhao , Komarow, Lauren, Jiang, Jianping , Boutzoukas, Angelique , Chen, Liang , Herc, Erica, Doi, Yohei, Arias, Cesar A, Jacob, J, Satlin, Michael J. , Huskins, W Charles, Dhar, Sorabh, Shelburne, Samuel A, Hill, Carol, Sadler, Jacob M., Hill, Bravada M, Greenwood-Quaintance, Kerryl E, Schmidt-Malan, Suzannah M., Patel, Robin, Fowler, Vance G, Tamma, Pranita D, Kreiswirth, Barry N, Group, for the Antibacterial Resistance Leadership, Chambers, Chip, Evans, Scott, Hamasaki, Toshi, Cross, Heather, Harris, Anthony, Pettigrew, Melinda M. , Duin, David van, Boucher, Helen , Dixon, Dennis O., Ghazaryan, Varduhi , Zou, Lanling, Raterman, Erica, Samuel, Tamika, Moon, Kyung, Hanson, Kim, Holland, Thomas, Lodise, Tom, Shelburne, Sam, Banerjee, Ritu, Cosgrove, Sara, Paterson, David, Lautenbach, Ebbing , Mehigan, Maureen, Doernberg, Sarah, Doi, Yohei , Chen, Liang , Boutzoukas, Angelique E , Jiang, Jianping , Doi, Yohei , Albin, Owen , Saade, Elie , Miller, Loren G , Jacob, Jesse T , Satlin, Michael J , Krsak, Martin , Huskins, W Charles , Shelburne, Samuel A , Hill, Carol , Alby, Kevin , Sadler, Jacob M , Hill, Bravada M , Patel, Robin , Fowler, Vance G. , Tamma, Pranita D , van Duin, David , Pettigrew, M M , Evans, Scott R , Ge, Lizhao , Komarow, Lauren , Garcia‐Diaz, Julia , Herc, Erica , Arias, César A. , Albin, Owen , Saade, Elie , Jacob, Jesse T. , Kršák, Martin , Huskins, W. Charles , Dhar, Sorabh , Shelburne, Samuel A. , Hill, Carol , Alby, Kevin , Greenwood‐Quaintance, Kerryl E. , Patel, Robin , Tamma, Pranita D. , Kreiswirth, Barry N , Evans, Scott, Raterman, Erica L., Samuel, Tamika, Banerjee, Ritu , Cosgrove, Sara E. , Paterson, David L. , Mehigan, Maureen
Clinical Infectious Diseases | March 4, 2026 | Volume: 83 | Issue: 1 | Pages: e27-e37
Abstract Background Ceftriaxone-resistant Escherichia coli infections are increasingly common, partially because of the emergence of E. coli sequence type 131 (ST131), including its subclade C2/H30Rx, which produce extended-spectrum β-lactamases. Methods A prospective cohort including 14 US sites, which enrolled monomicrobial ceftriaxone-resistant and susceptible E. coli bloodstream infection (BSI) cases in a 1:1 ratio, was used to compare ST131 versus non-ST131 E. coli BSI, with specific attention to E. coli ST131 C2/H30Rx. Desirability of outcome ranking was determined at 30 days after infection onset. Results This analysis included 282 patients with E. coli BSI; 43% (121/282) were E. coli ST131 and 23% (66/282) belonged to the C2/H30Rx subclade. Resistance to ceftriaxone was present in 79% (96/121) ST131, 86% (57/66) E. coli ST131 C2/H30Rx, and 27% (43/161) E. coli non-ST131. Compared to patients with non-ST131 E. coli BSI, patients with ST131 BSI were older (median 70 years, [Q1 62, Q3 76] years vs 65 years, [51, 74]; P = .005) and more often admitted from long-term care facilities (21/121 [17%] vs 7/161 [4%], P < .001). Overall and empiric carbapenem use was more frequent in the treatment of patients with ST131 BSI compared with non-ST131 BSI (overall 89/121 [74%] vs 50/161 [31%]; empiric: 58/121 [48%] vs 31/161 [19%], P < .001). Desirability of outcome ranking outcomes were similar between groups. Conclusions Most ceftriaxone-resistant E. coli from US patients with E. coli BSI belong to ST131, particularly E. coli ST131 C2/H30Rx, serving as an important driver of carbapenem use.
International Epidemiology of Carbapenemase-Producing Escherichia coli
Boutzoukas, Angelique E , Komarow, Lauren , Chen, Liang , Hanson, Blake , Liu, Zhengyin , Mendoza, Soraya Salcedo, Ordóñez, Karen , Wang, Minggui , Ge, Lizhao , Giri, Abhigya, Hill, Carol , Baum, Keri, Kreiswirth, Barry N. , Patel, Robin , Arias, César A. , Chambers, Henry F. , Fowler, Vance G. , Investigators, Multi-Drug Resistant Organism Network, Souha, S Kanj, Jean, Francois Jabbour, Fujie, Zhang, Judith, J Lok, Robert, A Salata, Martin, Stryjewski, Valentina, Di Castelnuovo, Jose, Millan Oñate Gutierrez, Eric, Cober, Susan, Richter, Deverick, J Anderson, Beth, Evans, Carol, Hill, Heather, Reich, Keri, Baum, Rebekka, Arias, Vance, G Fowler, Karen, Ordoñez, Jesse, T Jacob, Li, Linghua , Barry, Neil, Samit, Desai, Erica, Herc, Ezequiel, Cordova, Maria, R Ponisio, Samuel, Vichez, Marisa, Laëtitia , Sandra, Valderrama, Jairo, Figueroa, Cesar, A Arias, An, Qiang , Diane, Panesso, Kirsten, R., Truc, Thanh, Jiachun, Su, Jiang, Jianping , Ming-gui, Wang, Xu, Xiaogang , Yang, Yang , Jose, M Munita, Maria, Spencer, Thamer, Alenazi, Robert, Alain, Steven, Hersch, Susan, Davies, Charles, Huskins, Kerry, G, Robin, Patel, Suzannah, Schmidt-Malan, Sara, Revolinski, Glenn, Wortmann, Robert, C Kalayjian, Greg, Weston, Belinda, Ostrowsky, Gopi, Patel, Daniel, E Furst, Angela, Kim, Julia, Garcia-Diaz, Soraya, Salcedo, John, Jeffy, Zhengyin, Liu, Andrew, Henderson, David, Louis, Qing, Xie, Keith, S Kaye, Gao, Hainv , Yu, Yunsong , Mary, Waters, Bettina, C Fries, Brandon, Eilertson, Kean, Lee Chew, Nares, Smitasin, Paul, Ananth Tambyah, Jason, Christopher, Anton, Peleg, Marcel, L. Saint, Lan-juan, LI , Lauren, Komarow, Lizhao, Ge, Scott, Evans, Todd, McCarty, Henry, Fitjerald , Omai, B Garner, Lilian, M Abbo, David, van Duin, Ebbing, Lautenbach, Jennifer, Harrington, Yohei, Doi, Darren, W Logan, Blake, Hanson, Jinnethe, Reyes, Maria, Virginia Villegas Botero, Lorena, Diaz, Federico, P., Ritu, Banerjee, Sorabh, Dhar, Michael, Joy S, Zhiyong, Zong, Stryjewski, Martín E. , Villegas, María Virginia , Wang, Minggui , Evans, Scott R , Patel, Robin , van Duin, David , Pérez, Federico , Jiang, Jianping , Boutzoukas, Angelique , Chen, Liang , Villegas, Maria Virginia , Kanj, Souha S. , Paterson, David L. , Evans, Scott , Bonomo, Robert A. , Kreiswirth, Barry N , Arias, César A. , Fowler, Vance G. , Investigators, Multi-Drug Resistant Organism Network, Souha, S Kanj, Fujie, Zhang, Jose, Millan-Onate, Eric, Cober, Barry, N Kreiswirth, Claudia, Manca, Marisa, L Sanchez, An, Q Dinh, Kirsten, Rydell, Hu, Fupin , Maria, Spencer-Sandino, Robert, A Bonomo, Steven, H Marshall, Susan, D Rudin, Glenn, Wortmann, Gopi, Patel, Zhengyin, Liu, David, L Paterson, Qing, Xie, Marimuthu, Kalisvar , Anton, Peleg, Henry, F Chambers, Ebbing, Lautenbach, Jennifer, H Han, Lorena, Diaz, Federico, Perez, Ritu, Banerjee, Zhiyong, Zong
Clinical Infectious Diseases | May 8, 2023 | Volume: 77 | Issue: 4 | Pages: 499-509
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.