International epidemiology of carbapenemase-producing Escherichia coli
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
E. coli; carbapenem resistance; multi-drug resistance
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.
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.
Biostatistics and Bioinformatics