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