AUTHOR=Dahdouh Elias , Gómez-Marcos Laro , Cañada-García Javier E. , de Arellano Eva Ramírez , Sánchez-García Aida , Sánchez-Romero Isabel , López-Urrutia Luis , de la Iglesia Pedro , Gonzalez-Praetorius Alejandro , Sotelo Jared , Valle-Millares Daniel , Alonso-González Isabela , Bautista Verónica , Lara Noelia , García-Cobos Silvia , Cercenado Emilia , Aracil Belén , Oteo-Iglesias Jesús , Pérez-Vázquez María ,  Spanish Eco-Carba Study Group , Casquero Verónica , Valiente Olga , Mosquera Almudena Alhambra , Ndongo Alia Eworo , Real Susana Hernando , Ruiz-Velasco Luis Moisés , Leiva José , Balado Nieves , Ortega Adriana , Moreno Mar Olga Pérez , Bordes Ana , del Rosario Quintana Cristobal , Portillo María Eugenia , Baranda Caridad Sainz de , Trujillo Gloria , Palop Begoña , Aldea-Mansilla Carmen , Cuadros Juan , Gil Yolanda , Fernández-Bermejo Soledad Illescas , Ramos Ana , Giner Salvador , Pernas Antonio Casabella , Lafont M. Pilar Ortega , Vaquero María Huertas , Antolín Isabel , Pallarés Ma de los Ángeles , Iglesias Beatriz , Gómez-Bertomeu Frederic , López-Calleja Ana Isabel , Zamarrón Pilar 

TITLE=Characterizing carbapenemase-producing Escherichia coli isolates from Spain: high genetic heterogeneity and wide geographical spread

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=14

YEAR=2024

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2024.1390966

DOI=10.3389/fcimb.2024.1390966

ISSN=2235-2988

ABSTRACT=<sec><title>Introduction</title><p>Carbapenemase-Producing <italic>Escherichia coli</italic> (CP-Eco) isolates, though less prevalent than other CP-Enterobacterales, have the capacity to rapidly disseminate antibiotic resistance genes (ARGs) and cause serious difficult-to-treat infections. The aim of this study is phenotypically and genotypically characterizing CP-Eco isolates collected from Spain to better understand their resistance mechanisms and population structure.</p></sec><sec><title>Methods</title><p>Ninety representative isolates received from 2015 to 2020 from 25 provinces and 59 hospitals Spanish hospitals were included. Antibiotic susceptibility was determined according to EUCAST guidelines and whole-genome sequencing was performed. Antibiotic resistance and virulence-associated genes, phylogeny and population structure, and carbapenemase genes-carrying plasmids were analyzed.</p></sec><sec><title>Results and discussion</title><p>The 90 CP-Eco isolates were highly polyclonal, where the most prevalent was ST131, detected in 14 (15.6%) of the isolates. The carbapenemase genes detected were <italic>bla</italic><sub>OXA-48</sub> (45.6%), <italic>bla</italic><sub>VIM-1</sub> (23.3%), <italic>bla</italic><sub>NDM-1</sub> (7.8%), <italic>bla</italic><sub>KPC-3</sub> (6.7%), and <italic>bla</italic><sub>NDM-5</sub> (6.7%). Forty (44.4%) were resistant to 6 or more antibiotic groups and the most active antibiotics were colistin (98.9%), plazomicin (92.2%) and cefiderocol (92.2%). Four of the seven cefiderocol-resistant isolates belonged to ST167 and six harbored <italic>bla</italic><sub>NDM</sub>. Five of the plazomicin-resistant isolates harbored <italic>rmt</italic>. IncL plasmids were the most frequent (45.7%) and eight of these harbored <italic>bla</italic><sub>VIM-1</sub>. <italic>bla</italic><sub>OXA-48</sub> was found in IncF plasmids in eight isolates. Metallo-β-lactamases were more frequent in isolates with resistance to six or more antibiotic groups, with their genes often present on the same plasmid/integron. ST131 isolates were associated with <italic>sat</italic> and <italic>pap</italic> virulence genes. This study highlights the genetic versatility of CP-Eco and its potential to disseminate ARGs and cause community and nosocomial infections.</p></sec>