International epidemiology of carbapenemase-producing Escherichia coli

Angelique E. Boutzoukas, Duke University, Durham, North Carolina, US.
Lauren Komarow, The Biostatistics Center, George Washington University, Rockville, Maryland, USA.
Liang Chen, Center for Discovery and Innovation, Hackensack Meridian Health , Nutley, New Jersey, USA.
Blake Hanson, Center for Infectious Diseases and Microbial Genomics, UTHealth, McGovern School of Medicine at Houston, Houston, Texas, USA.
Souha S. Kanj, Division of Infectious Diseases, and Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
Zhengyin Liu, Infectious Disease Section, Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, China.
Soraya Salcedo Mendoza, Servicio de Infectología, Organizacion Clinica General del Norte, Barranquilla, Colombia.
Karen Ordoñez, Department of Infectious Diseases, E.S.E. Hospital Universitario, San Jorge de Pereira, Pereira, Colombia.
Minggui Wang, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.
David L. Paterson, ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Scott Evans, The Biostatistics Center, George Washington University, Rockville, Maryland, USA.
Lizhao Ge, The Biostatistics Center, George Washington University, Rockville, Maryland, USA.
Abhigya Giri, The Biostatistics Center, George Washington University, Rockville, Maryland, USA.
Carol Hill, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Keri Baum, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Robert A. Bonomo, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA and VA _ Case Center for Antibiotic Resistance and Epidemiology (Case-VA CARES).
Barry Kreiswirth, Center for Discovery and Innovation, Hackensack Meridian Health , Nutley, New Jersey, USA.
Robin Patel, Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology and Division of Public Health, Infectious Diseases, and Occupational medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Cesar A. Arias, Division of Infectious Diseases and Center for Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, Texas, USA.
Henry F. Chambers, Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Vance G. Fowler, Duke University, Durham, North Carolina, US.
David van Duin, Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, United States of America.

Document Type

Journal Article

Publication Date

5-8-2023

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

DOI

10.1093/cid/ciad288

Keywords

E. coli; carbapenem resistance; multi-drug resistance

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 (MBL) were compared. The primary outcome was desirability of outcome ranking (DOOR) at 30 days after index culture. RESULTS: Of the 114 CP-Ec isolates in 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 source (49% vs. 29%), less often met criteria for infection (39% vs 58%, p=0.04), and had lower acuity of illness when compared to non-MBL-Ec. Among patients with infection, the probability of a better DOOR outcome for a randomly selected patient with MBL-Ec as compared to 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=0.02) and 90-day (39% vs 0%, p=0.001) mortality compared with MBL-Ec. CONCLUSION: 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.

Department

Biostatistics and Bioinformatics

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