International Epidemiology of Carbapenemase-Producing Escherichia coli
Abstract Background 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. Methods Patients with CP-E...
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| Veröffentlicht in: | Clinical infectious diseases 2023-08, Vol.77 (4), p.499-509 |
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| creator | Boutzoukas, Angelique E Komarow, Lauren Chen, Liang Hanson, Blake Kanj, Souha S Liu, Zhengyin Salcedo Mendoza, Soraya Ordoñez, Karen Wang, Minggui Paterson, David L Evans, Scott Ge, Lizhao Giri, Abhigya Hill, Carol Baum, Keri Bonomo, Robert A Kreiswirth, Barry Patel, Robin Arias, Cesar A Chambers, Henry F Fowler, Vance G van Duin, David |
| description | Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Carbapenemase-producing Escherichia coli (CP-Ec) are concerning given the global prevalence of E. coli in many infection sites and limited available treatment options. We observed regional variation in CP-Ec, often among high-risk genotypes. Mortality was lower in those infected with metallo-β-lactamase producers. |
| doi_str_mv | 10.1093/cid/ciad288 |
| format | Article |
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Background
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.
Methods
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.
Results
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.
Conclusions
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.
Carbapenemase-producing Escherichia coli (CP-Ec) are concerning given the global prevalence of E. coli in many infection sites and limited available treatment options. We observed regional variation in CP-Ec, often among high-risk genotypes. Mortality was lower in those infected with metallo-β-lactamase producers.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciad288</identifier><identifier>PMID: 37154071</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Bacterial Proteins - genetics ; beta-Lactamases - genetics ; Carbapenem-Resistant Enterobacteriaceae - genetics ; Escherichia coli - genetics ; Humans ; Major ; Microbial Sensitivity Tests ; Prospective Studies</subject><ispartof>Clinical infectious diseases, 2023-08, Vol.77 (4), p.499-509</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c376t-d6602f61b7df65d6f2d072249e7b67bc4c5179c248447f670224f5b0a15b40613</citedby><cites>FETCH-LOGICAL-c376t-d6602f61b7df65d6f2d072249e7b67bc4c5179c248447f670224f5b0a15b40613</cites><orcidid>0000-0001-7682-5859 ; 0000-0002-9477-1492 ; 0000-0003-3186-172X ; 0000-0003-4784-3227 ; 0000-0001-6344-4141 ; 0000-0003-2949-7818</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37154071$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boutzoukas, Angelique E</creatorcontrib><creatorcontrib>Komarow, Lauren</creatorcontrib><creatorcontrib>Chen, Liang</creatorcontrib><creatorcontrib>Hanson, Blake</creatorcontrib><creatorcontrib>Kanj, Souha S</creatorcontrib><creatorcontrib>Liu, Zhengyin</creatorcontrib><creatorcontrib>Salcedo Mendoza, Soraya</creatorcontrib><creatorcontrib>Ordoñez, Karen</creatorcontrib><creatorcontrib>Wang, Minggui</creatorcontrib><creatorcontrib>Paterson, David L</creatorcontrib><creatorcontrib>Evans, Scott</creatorcontrib><creatorcontrib>Ge, Lizhao</creatorcontrib><creatorcontrib>Giri, Abhigya</creatorcontrib><creatorcontrib>Hill, Carol</creatorcontrib><creatorcontrib>Baum, Keri</creatorcontrib><creatorcontrib>Bonomo, Robert A</creatorcontrib><creatorcontrib>Kreiswirth, Barry</creatorcontrib><creatorcontrib>Patel, Robin</creatorcontrib><creatorcontrib>Arias, Cesar A</creatorcontrib><creatorcontrib>Chambers, Henry F</creatorcontrib><creatorcontrib>Fowler, Vance G</creatorcontrib><creatorcontrib>van Duin, David</creatorcontrib><creatorcontrib>Multi-Drug Resistant Organism Network Investigators</creatorcontrib><title>International Epidemiology of Carbapenemase-Producing Escherichia coli</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Carbapenemase-producing Escherichia coli (CP-Ec) are concerning given the global prevalence of E. coli in many infection sites and limited available treatment options. We observed regional variation in CP-Ec, often among high-risk genotypes. Mortality was lower in those infected with metallo-β-lactamase producers.</description><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Bacterial Proteins - genetics</subject><subject>beta-Lactamases - genetics</subject><subject>Carbapenem-Resistant Enterobacteriaceae - genetics</subject><subject>Escherichia coli - genetics</subject><subject>Humans</subject><subject>Major</subject><subject>Microbial Sensitivity Tests</subject><subject>Prospective Studies</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LAzEQhoMotlZP3mVPIshqspuvnkRKq4WCHvQcsvloI7ubNdkV-u-NtIpePAwzMA_vDA8A5wjeIDgtb5XTqaQuOD8AY0RKllMyRYdphoTnmJd8BE5ifIMQIQ7JMRiVDBEMGRqDxbLtTWhl73wr62zeOW0a52u_3mbeZjMZKtmZ1jQymvw5eD0o166zeVQbE5zaOJkpX7tTcGRlHc3Zvk_A62L-MnvMV08Py9n9Klclo32uKYWFpahi2lKiqS00ZEWBp4ZVlFUKK4LYVBWYY8wsZTDtLKmgRKTCkKJyAu52ud1QNUYr0_ZB1qILrpFhK7x04u-mdRux9h8CQYwxhGVKuNonBP8-mNiLxkVl6lq2xg9RFBwhQhllOKHXO1QFH2Mw9ucOguJLvUjqxV59oi9-v_bDfrtOwOUO8EP3b9In_JuNtA</recordid><startdate>20230822</startdate><enddate>20230822</enddate><creator>Boutzoukas, Angelique E</creator><creator>Komarow, Lauren</creator><creator>Chen, Liang</creator><creator>Hanson, Blake</creator><creator>Kanj, Souha S</creator><creator>Liu, Zhengyin</creator><creator>Salcedo Mendoza, Soraya</creator><creator>Ordoñez, Karen</creator><creator>Wang, Minggui</creator><creator>Paterson, David L</creator><creator>Evans, Scott</creator><creator>Ge, Lizhao</creator><creator>Giri, Abhigya</creator><creator>Hill, Carol</creator><creator>Baum, Keri</creator><creator>Bonomo, Robert A</creator><creator>Kreiswirth, Barry</creator><creator>Patel, Robin</creator><creator>Arias, Cesar A</creator><creator>Chambers, Henry F</creator><creator>Fowler, Vance G</creator><creator>van Duin, David</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7682-5859</orcidid><orcidid>https://orcid.org/0000-0002-9477-1492</orcidid><orcidid>https://orcid.org/0000-0003-3186-172X</orcidid><orcidid>https://orcid.org/0000-0003-4784-3227</orcidid><orcidid>https://orcid.org/0000-0001-6344-4141</orcidid><orcidid>https://orcid.org/0000-0003-2949-7818</orcidid></search><sort><creationdate>20230822</creationdate><title>International Epidemiology of Carbapenemase-Producing Escherichia coli</title><author>Boutzoukas, Angelique E ; Komarow, Lauren ; Chen, Liang ; Hanson, Blake ; Kanj, Souha S ; Liu, Zhengyin ; Salcedo Mendoza, Soraya ; Ordoñez, Karen ; Wang, Minggui ; Paterson, David L ; Evans, Scott ; Ge, Lizhao ; Giri, Abhigya ; Hill, Carol ; Baum, Keri ; Bonomo, Robert A ; Kreiswirth, Barry ; Patel, Robin ; Arias, Cesar A ; Chambers, Henry F ; Fowler, Vance G ; van Duin, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c376t-d6602f61b7df65d6f2d072249e7b67bc4c5179c248447f670224f5b0a15b40613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Bacterial Proteins - genetics</topic><topic>beta-Lactamases - genetics</topic><topic>Carbapenem-Resistant Enterobacteriaceae - genetics</topic><topic>Escherichia coli - genetics</topic><topic>Humans</topic><topic>Major</topic><topic>Microbial Sensitivity Tests</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boutzoukas, Angelique E</creatorcontrib><creatorcontrib>Komarow, Lauren</creatorcontrib><creatorcontrib>Chen, Liang</creatorcontrib><creatorcontrib>Hanson, Blake</creatorcontrib><creatorcontrib>Kanj, Souha S</creatorcontrib><creatorcontrib>Liu, Zhengyin</creatorcontrib><creatorcontrib>Salcedo Mendoza, Soraya</creatorcontrib><creatorcontrib>Ordoñez, Karen</creatorcontrib><creatorcontrib>Wang, Minggui</creatorcontrib><creatorcontrib>Paterson, David L</creatorcontrib><creatorcontrib>Evans, Scott</creatorcontrib><creatorcontrib>Ge, Lizhao</creatorcontrib><creatorcontrib>Giri, Abhigya</creatorcontrib><creatorcontrib>Hill, Carol</creatorcontrib><creatorcontrib>Baum, Keri</creatorcontrib><creatorcontrib>Bonomo, Robert A</creatorcontrib><creatorcontrib>Kreiswirth, Barry</creatorcontrib><creatorcontrib>Patel, Robin</creatorcontrib><creatorcontrib>Arias, Cesar A</creatorcontrib><creatorcontrib>Chambers, Henry F</creatorcontrib><creatorcontrib>Fowler, Vance G</creatorcontrib><creatorcontrib>van Duin, David</creatorcontrib><creatorcontrib>Multi-Drug Resistant Organism Network Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boutzoukas, Angelique E</au><au>Komarow, Lauren</au><au>Chen, Liang</au><au>Hanson, Blake</au><au>Kanj, Souha S</au><au>Liu, Zhengyin</au><au>Salcedo Mendoza, Soraya</au><au>Ordoñez, Karen</au><au>Wang, Minggui</au><au>Paterson, David L</au><au>Evans, Scott</au><au>Ge, Lizhao</au><au>Giri, Abhigya</au><au>Hill, Carol</au><au>Baum, Keri</au><au>Bonomo, Robert A</au><au>Kreiswirth, Barry</au><au>Patel, Robin</au><au>Arias, Cesar A</au><au>Chambers, Henry F</au><au>Fowler, Vance G</au><au>van Duin, David</au><aucorp>Multi-Drug Resistant Organism Network Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>International Epidemiology of Carbapenemase-Producing Escherichia coli</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2023-08-22</date><risdate>2023</risdate><volume>77</volume><issue>4</issue><spage>499</spage><epage>509</epage><pages>499-509</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Carbapenemase-producing Escherichia coli (CP-Ec) are concerning given the global prevalence of E. coli in many infection sites and limited available treatment options. We observed regional variation in CP-Ec, often among high-risk genotypes. Mortality was lower in those infected with metallo-β-lactamase producers.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>37154071</pmid><doi>10.1093/cid/ciad288</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-7682-5859</orcidid><orcidid>https://orcid.org/0000-0002-9477-1492</orcidid><orcidid>https://orcid.org/0000-0003-3186-172X</orcidid><orcidid>https://orcid.org/0000-0003-4784-3227</orcidid><orcidid>https://orcid.org/0000-0001-6344-4141</orcidid><orcidid>https://orcid.org/0000-0003-2949-7818</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Bacterial Proteins - genetics beta-Lactamases - genetics Carbapenem-Resistant Enterobacteriaceae - genetics Escherichia coli - genetics Humans Major Microbial Sensitivity Tests Prospective Studies |
| title | International Epidemiology of Carbapenemase-Producing Escherichia coli |
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