International Epidemiology of Carbapenemase-Producing Escherichia coli
Authors: Boutzoukas Angelique E , Komarow Lauren , Chen Liang , Hanson Blake , Kanj Souha S , Liu Zhengyin , Salcedo Mendoza Soraya , 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 , van Duin David ,   Multi-Drug Resistant Organism Network Investigators, Souha S Kanj , Jean Francois (Jeff) Jabbour , Fujie Zhang , Judith J Lok , Robert A Salata , Martin Stryjewski , Valentina Di Castelnuovo , Jose Millan Oñate Gutierrez , Eric Cober , Susan Richter , Deverick J Anderson , Beth Evans , Carol Hill , Heather R Cross , Keri Baum , Rebekka Arias , Vance G Fowler , Karen Ordoñez , Jesse T Jacob , Linghua Li , Barry N Kreiswirth , Claudia Manca , Liang Chen , Samit Desai , Erica Herc , Ezequiel Cordova , Maria Rioseco , Samuel Vichez , Marisa L Sanchez , Sandra Valderrama , Jairo Figueroa , Cesar A Arias , An Q Dinh , Diane Panesso , Kirsten Rydell , Truc T Tran , Fupin Hu , Jiachun Su , Jianping Jiang , Minggui Wang , Xiaogang Xu , Yang Yang , Jose M Munita , Maria Spencer , Thamer Alenazi , Robert A Bonomo , Steven H Marshall , Susan D Rudin , Charles Huskins , Kerry Greenwood-Quaintance , Robin Patel , Suzannah Schmidt-Malan , Sara Revolinski , Glenn Wortmann , Robert C Kalayjian , Greg Weston , Belinda Ostrowsky , Gopi Patel , Daniel Eiras , Angela Kim , Julia Garcia-Diaz , Soraya Salcedo , John J Farrell , Zhengyin Liu , Andrew Henderson , David L Paterson , Qing Xie , Keith S Kaye , Hainv Gao , Yunsong Yu , Mary Waters , Bettina C Fries , Brandon Eilertson , Kalisvar Marimuthu , Kean Lee Chew , Nares Smitasin , Paul Ananth Tambyah , Jason C Gallagher , Anton Peleg , Marcel Leroi , Lanjuan Li , Lauren Komarow , Lizhao Ge , Scott Evans , Todd McCarty , Henry F Chambers , Omai B Garner , Lilian M Abbo , David van Duin , Ebbing Lautenbach , Jennifer H Han , Yohei Doi , Darren Wong , Blake Hanson , Jinnethe Reyes , Maria Virginia Villegas Botero , Lorena Diaz , Federico Perez , Ritu Banerjee , Sorabh Dhar , Michael J Satlin , Zhiyong Zong 
Published: May 2023

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 (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.