International Epidemiology of Carbapenemase-Producing Escherichia coli

Angelique E. Boutzoukas, Lauren Komarow, Liang Chen, Blake Hanson, Souha S. Kanj, Zhengyin Liu, Soraya Salcedo Mendoza, Karen Ordonez, Minggui Wang, David L. Paterson, Scott Evans, Lizhao Ge, Abhigya Giri, Carol Hill, Keri Baum, Robert A. Bonomo, Barry Kreiswirth, Robin Patel, Cesar A. Arias, Henry F. ChambersVance G. Fowler, David Van Duin

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)499-509
Number of pages11
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Issue number4
StatePublished - Aug 15 2023


  • Humans
  • Prospective Studies
  • beta-Lactamases/genetics
  • Escherichia coli/genetics
  • Bacterial Proteins/genetics
  • Carbapenem-Resistant Enterobacteriaceae/genetics
  • Anti-Bacterial Agents/pharmacology
  • Microbial Sensitivity Tests

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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