TY - JOUR
T1 - International Epidemiology of Carbapenemase-Producing Escherichia coli
AU - Boutzoukas, Angelique E.
AU - Komarow, Lauren
AU - Chen, Liang
AU - Hanson, Blake
AU - Kanj, Souha S.
AU - Liu, Zhengyin
AU - Salcedo Mendoza, Soraya
AU - Ordonez, Karen
AU - Wang, Minggui
AU - Paterson, David L.
AU - Evans, Scott
AU - Ge, Lizhao
AU - Giri, Abhigya
AU - Hill, Carol
AU - Baum, Keri
AU - Bonomo, Robert A.
AU - Kreiswirth, Barry
AU - Patel, Robin
AU - Arias, Cesar A.
AU - Chambers, Henry F.
AU - Fowler, Vance G.
AU - Van Duin, David
N1 - Funding Information:
Financial support. This work was supported by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH) under award number UM1AI104681 and the US Eunice Kennedy Shriver National institute of child health and human development T32 training grant (1T32HD094671).
Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved.
PY - 2023/8/15
Y1 - 2023/8/15
N2 - 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.
AB - 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.
KW - Humans
KW - Prospective Studies
KW - beta-Lactamases/genetics
KW - Escherichia coli/genetics
KW - Bacterial Proteins/genetics
KW - Carbapenem-Resistant Enterobacteriaceae/genetics
KW - Anti-Bacterial Agents/pharmacology
KW - Microbial Sensitivity Tests
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U2 - 10.1093/cid/ciad288
DO - 10.1093/cid/ciad288
M3 - Article
C2 - 37154071
SN - 1058-4838
VL - 77
SP - 499
EP - 509
JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
IS - 4
ER -