Division of Infectious Diseases, Duke University, Durham, North Carolina, USA.
Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Clin Infect Dis. 2023 Aug 22;77(4):499-509. doi: 10.1093/cid/ciad288.
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.
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.
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.
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.
产碳青霉烯酶（CP）的大肠埃希菌（CP-Ec）是全球公共卫生的威胁。我们旨在描述从一个前瞻性队列中获得的来自多个国家 CP-Ec 分离株的患者的临床和分子流行病学和结局。
从 6 个国家的 26 家医院招募 CP-Ec 患者。收集临床数据，并对分离株进行全基因组测序。比较具有或不具有金属β-内酰胺酶（MBLs）的分离株的临床和分子特征以及结局。主要结局是指数培养后 30 天的结局排序适宜性（DOOR）。
在耐碳青霉烯类抗生素的克雷伯氏菌和肠杆菌科-2 联盟（CRACKLE-2）中，共有 114 株 CP-Ec 分离株，其中 49 株携带 MBL，最常见的是 blaNDM-5（38/49，78%）。注意到明显的区域差异，MBL-Ec 主要存在于中国患者中（23/49）。临床方面，MBL-Ec 更常来自尿液来源（49%比 29%），不符合感染标准的情况较少（39%比 58%，P=0.04），与非 MBL-Ec 相比，疾病的严重程度较低。在感染患者中，与非 MBL-Ec 相比，随机选择的 MBL-Ec 患者的 DOOR 结局更好的概率为 62%（95%CI：48.2-74.3%）。在感染患者中，非 MBL-Ec 的 30 天（26%比 0%；P=0.02）和 90 天（39%比 0%；P=0.001）死亡率高于 MBL-Ec。
观察到 CP-Ec 的出现，具有重要的地理差异。MBL-Ec 和非 MBL-Ec 之间的细菌特征、临床表现和结局存在差异。非 MBL 分离株的死亡率较高，这些分离株更常从血液中分离出来，但这些发现可能受到区域差异的影响。
