Bloodstream Infections Due to Carbapenemase-Producing Escherichia coli: A Comprehensive Review

Area of Science:

• Microbiology
• Infectious Diseases
• Genomics

Background:

• Carbapenemase-producing Escherichia coli (CP-Ec) is a significant driver of global antimicrobial resistance.
• CP-Ec exhibits genomic plasticity and plasmid-mediated spread, increasingly causing bloodstream infections.
• The prevalence of NDM, OXA-48-like, and KPC carbapenemases in CP-Ec is expanding.

Purpose of the Study:

• To provide a comprehensive review of the global epidemiology of CP-Ec.
• To summarize molecular features, treatment options, and transmission dynamics of CP-Ec.
• To highlight key high-risk clones and their role in international CP-Ec spread.

Main Methods:

• Systematic literature review of global CP-Ec epidemiology.
• Analysis of molecular characteristics, including carbapenemase types and plasmid backbones.
• Examination of clonal structures and transmission dynamics of key CP-Ec clones.

Main Results:

• CP-Ec bloodstream infections are associated with severe outcomes and limited treatment options, especially for NDM producers.
• High-risk clones such as ST410, ST167, and ST131 are major contributors to international CP-Ec dissemination.
• Treatment failures with last-resort antibiotics are increasingly reported for CP-Ec infections.

Conclusions:

• CP-Ec bloodstream infections pose a growing clinical challenge requiring improved management strategies.
• Enhanced global surveillance and genomic epidemiology integration are crucial for controlling CP-Ec.
• Optimized antimicrobial stewardship and targeted infection control are essential to mitigate CP-Ec's impact.