International epidemiology of carbapenemase-producing Escherichia coli

Authors

• 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.

APA Citation

Boutzoukas, Angelique E.; Komarow, Lauren; Chen, Liang; Hanson, Blake; Kanj, Souha S.; Liu, Zhengyin; Mendoza, Soraya Salcedo; Ordoñez, Karen; Wang, Minggui; Paterson, David L.; Evans, Scott; Ge, Lizhao; Giri, Abhigya; Hill, Carol; Baum, Keri; Bonomo, Robert A.; Kreiswirth, Barry; Patel, Robin; Arias, Cesar A.; Chambers, Henry F.; Fowler, Vance G.; and van Duin, David, "International epidemiology of carbapenemase-producing Escherichia coli" (2023). GW Authored Works. Paper 2936.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2936

Department

Biostatistics and Bioinformatics