Escherichia coli ST131 Drives Carbapenem Use for E. coli Bloodstream Infections

for the Antibacterial Resistance Leadership Group

doi:10.1093/cid/ciag160

Escherichia coli ST131 Drives Carbapenem Use for E. coli Bloodstream Infections

for the Antibacterial Resistance Leadership Group

Administration (SPH)

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Abstract

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.

Original language	English (US)
Pages (from-to)	e27-e37
Journal	Clinical Infectious Diseases
Volume	83
Issue number	1
DOIs	https://doi.org/10.1093/cid/ciag160
State	Published - Jul 2026

Bibliographical note

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].

Keywords

E. coli
ST131
bacteremia
carbapenems
ceftriaxone resistance

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10.1093/cid/ciag160

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@article{d40fbc6c836e46abb5fa5ab42ac3fcd6,

title = "Escherichia coli ST131 Drives Carbapenem Use for E. coli Bloodstream Infections",

abstract = "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.",

keywords = "E. coli, ST131, bacteremia, carbapenems, ceftriaxone resistance",

author = "\{for the Antibacterial Resistance Leadership Group\} and Mackow, \{Natalie A.\} and Wanying Shao and Lizhao Ge and Lauren Komarow and Jianping Jiang and Angelique Boutzoukas and Liang Chen and Julia Garcia-Diaz and Herc, \{Erica S.\} and Yohei Doi and Arias, \{Cesar A.\} and Owen Albin and Elie Saade and Miller, \{Loren G.\} and Jacob, \{Jesse T.\} and Satlin, \{Michael J.\} and Martin Krsak and Huskins, \{W. Charles\} and Sorabh Dhar and Shelburne, \{Samuel A.\} and Carol Hill and Kevin Alby and Sadler, \{Jacob M.\} and Hill, \{Bravada M.\} and Greenwood-Quaintance, \{Kerryl E.\} and Schmidt-Malan, \{Suzannah M.\} and Robin Patel and Fowler, \{Vance G.\} and Tamma, \{Pranita D.\} and Kreiswirth, \{Barry N.\} and \{van Duin\}, David and Chip Chambers and Scott Evans and Vance Fowler and Toshi Hamasaki and Robin Patel and Heather Cross and Anthony Harris and Melinda Pettigrew and \{van Duin\}, David and Helen Boucher and Dennis Dixon and Varduhi Ghazaryan and Lanling Zou and Erica Raterman and Tamika Samuel and Kyung Moon and Kim Hanson and Yohei Doi and Thomas Holland",

note = "Publisher Copyright: {\textcopyright} 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{\textemdash}for further information please contact [email protected].",

year = "2026",

month = jul,

doi = "10.1093/cid/ciag160",

language = "English (US)",

volume = "83",

pages = "e27--e37",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "1",

}

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

UR - https://www.scopus.com/pages/publications/105034125229#tab=citedBy

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 -

Escherichia coli ST131 Drives Carbapenem Use for E. coli Bloodstream Infections

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