TY - JOUR
T1 - Escherichia coli ST131 Drives Carbapenem Use for E. coli Bloodstream Infections
AU - for the Antibacterial Resistance Leadership Group
AU - Mackow, Natalie A.
AU - Shao, Wanying
AU - Ge, Lizhao
AU - Komarow, Lauren
AU - Jiang, Jianping
AU - Boutzoukas, Angelique
AU - Chen, Liang
AU - Garcia-Diaz, Julia
AU - Herc, Erica S.
AU - Doi, Yohei
AU - Arias, Cesar A.
AU - Albin, Owen
AU - Saade, Elie
AU - Miller, Loren G.
AU - Jacob, Jesse T.
AU - Satlin, Michael J.
AU - Krsak, Martin
AU - Huskins, W. Charles
AU - Dhar, Sorabh
AU - Shelburne, Samuel A.
AU - Hill, Carol
AU - Alby, Kevin
AU - Sadler, Jacob M.
AU - Hill, Bravada M.
AU - Greenwood-Quaintance, Kerryl E.
AU - Schmidt-Malan, Suzannah M.
AU - Patel, Robin
AU - Fowler, Vance G.
AU - Tamma, Pranita D.
AU - Kreiswirth, Barry N.
AU - van Duin, David
AU - Chambers, Chip
AU - Evans, Scott
AU - Fowler, Vance
AU - Hamasaki, Toshi
AU - Patel, Robin
AU - Cross, Heather
AU - Harris, Anthony
AU - Pettigrew, Melinda
AU - van Duin, David
AU - Boucher, Helen
AU - Dixon, Dennis
AU - Ghazaryan, Varduhi
AU - Zou, Lanling
AU - Raterman, Erica
AU - Samuel, Tamika
AU - Moon, Kyung
AU - Hanson, Kim
AU - Doi, Yohei
AU - Holland, Thomas
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2026/7
Y1 - 2026/7
N2 - Background: Ceftriaxone-resistant Escherichia coli infections are increasingly common, partially because of the emergence of E. coli sequence type 131 (ST131), including its subclade C2/H30Rx, which produce extended-spectrum β-lactamases. Methods: A prospective cohort including 14 US sites, which enrolled monomicrobial ceftriaxone-resistant and susceptible E. coli bloodstream infection (BSI) cases in a 1:1 ratio, was used to compare ST131 versus non-ST131 E. coli BSI, with specific attention to E. coli ST131 C2/H30Rx. Desirability of outcome ranking was determined at 30 days after infection onset. Results: This analysis included 282 patients with E. coli BSI; 43% (121/282) were E. coli ST131 and 23% (66/282) belonged to the C2/H30Rx subclade. Resistance to ceftriaxone was present in 79% (96/121) ST131, 86% (57/66) E. coli ST131 C2/H30Rx, and 27% (43/161) E. coli non-ST131. Compared to patients with non-ST131 E. coli BSI, patients with ST131 BSI were older (median 70 years, [Q1 62, Q3 76] years vs 65 years, [51, 74]; P = .005) and more often admitted from long-term care facilities (21/121 [17%] vs 7/161 [4%], P < .001). Overall and empiric carbapenem use was more frequent in the treatment of patients with ST131 BSI compared with non-ST131 BSI (overall 89/121 [74%] vs 50/161 [31%]; empiric: 58/121 [48%] vs 31/161 [19%], P < .001). Desirability of outcome ranking outcomes were similar between groups. Conclusions: Most ceftriaxone-resistant E. coli from US patients with E. coli BSI belong to ST131, particularly E. coli ST131 C2/H30Rx, serving as an important driver of carbapenem use.
AB - Background: Ceftriaxone-resistant Escherichia coli infections are increasingly common, partially because of the emergence of E. coli sequence type 131 (ST131), including its subclade C2/H30Rx, which produce extended-spectrum β-lactamases. Methods: A prospective cohort including 14 US sites, which enrolled monomicrobial ceftriaxone-resistant and susceptible E. coli bloodstream infection (BSI) cases in a 1:1 ratio, was used to compare ST131 versus non-ST131 E. coli BSI, with specific attention to E. coli ST131 C2/H30Rx. Desirability of outcome ranking was determined at 30 days after infection onset. Results: This analysis included 282 patients with E. coli BSI; 43% (121/282) were E. coli ST131 and 23% (66/282) belonged to the C2/H30Rx subclade. Resistance to ceftriaxone was present in 79% (96/121) ST131, 86% (57/66) E. coli ST131 C2/H30Rx, and 27% (43/161) E. coli non-ST131. Compared to patients with non-ST131 E. coli BSI, patients with ST131 BSI were older (median 70 years, [Q1 62, Q3 76] years vs 65 years, [51, 74]; P = .005) and more often admitted from long-term care facilities (21/121 [17%] vs 7/161 [4%], P < .001). Overall and empiric carbapenem use was more frequent in the treatment of patients with ST131 BSI compared with non-ST131 BSI (overall 89/121 [74%] vs 50/161 [31%]; empiric: 58/121 [48%] vs 31/161 [19%], P < .001). Desirability of outcome ranking outcomes were similar between groups. Conclusions: Most ceftriaxone-resistant E. coli from US patients with E. coli BSI belong to ST131, particularly E. coli ST131 C2/H30Rx, serving as an important driver of carbapenem use.
KW - E. coli
KW - ST131
KW - bacteremia
KW - carbapenems
KW - ceftriaxone resistance
UR - https://www.scopus.com/pages/publications/105034125229
U2 - 10.1093/cid/ciag160
DO - 10.1093/cid/ciag160
M3 - Article
C2 - 41795867
AN - SCOPUS:105034125229
SN - 1058-4838
VL - 83
SP - e27-e37
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 1
ER -