Citations 1
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.