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Escherichia coli ST131 Drives Carbapenem Use for E. coli Bloodstream Infections
Natalie A Mackow1, Wanying Shao2, Lizhao Ge2
1Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Summary
Ceftriaxone-resistant Escherichia coli infections are increasingly driven by the ST131 strain, especially the C2/H30Rx subclade. This finding highlights the need for updated treatment strategies for these resistant infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Ceftriaxone-resistant Escherichia coli (E. coli) infections are a growing public health concern.
- The emergence of E. coli sequence type 131 (ST131), particularly its C2/H30Rx subclade producing extended-spectrum β-lactamases (ESBL), is a key factor in this rise.
Purpose of the Study:
- To compare bloodstream infections (BSI) caused by E. coli ST131 versus non-ST131 strains.
- To specifically investigate the characteristics and outcomes of infections involving the E. coli ST131 C2/H30Rx subclade.
Main Methods:
- A prospective cohort study was conducted across 14 US sites.
- Monomicrobial E. coli BSI cases (ceftriaxone-resistant and susceptible) were enrolled in a 1:1 ratio.
- Desirability of outcome ranking (DOOR) was assessed at 30 days post-infection.
Main Results:
- E. coli ST131 accounted for 43% of E. coli BSI cases, with 23% belonging to the C2/H30Rx subclade.
- Ceftriaxone resistance was significantly higher in ST131 (79%) and C2/H30Rx (86%) compared to non-ST131 strains (27%).
- Patients with ST131 BSI were older, more likely from long-term care facilities, and received more carbapenem therapy.
Conclusions:
- The E. coli ST131 strain, especially the C2/H30Rx subclade, is a primary driver of ceftriaxone-resistant E. coli bloodstream infections in the US.
- These findings underscore the importance of ST131 in necessitating increased carbapenem use for treating resistant E. coli infections.
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