Characterisation, management, and outcomes of New Delhi metallo-β-lactamase-producing Escherichia coli: A case series

• Published in: Journal of Global Antimicrobial Resistance Vol. 40; pp. 42 - 46
• Main Authors: Shallal, Anita, Veve, Michael P., Kenney, Rachel M., Alangaden, George, Suleyman, Geehan
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2025; Elsevier
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antimicrobial resistance; Antimicrobial stewardship; beta-Lactamases - genetics; beta-Lactamases - metabolism; Carbapenemase production; Case series; Escherichia coli - drug effects; Escherichia coli - enzymology; Escherichia coli - genetics; Escherichia coli - isolation & purification; Escherichia coli Infections - drug therapy; Escherichia coli Infections - microbiology; Female; Humans; Infectious Disease; Male; Metallo-β-lactamases; Microbial Sensitivity Tests; Middle Aged; Multi-drug resistant organisms; NDM; Oral therapy; Risk Factors; Treatment Outcome; NDM; Oral therapy; Metallo-β-lactamases; Multi-drug resistant organisms; Carbapenemase production; Antimicrobial stewardship; Case series; Antimicrobial resistance
• ISSN: 2213-7165; 2213-7173; 2213-7173
• DOI: 10.1016/j.jgar.2024.11.017

•Infections with New Delhi metallo-β-lactamase-producing Escherichia coli are difficult to treat and data are limited.•In this large case series of nine patients with culture-positive infections, two patients were re-admitted for infection-related complications within 30 days and three patients died within 30 days.•Oral therapy with trimethoprim/sulfamethoxazole and intravenous cefiderocol were used in patients who had treatment success. New Delhi metallo-β-lactamase (NDM)-producing carbapenem-resistant Enterobacterales (CRE) is a globally growing threat. We sought to describe the microbiology, management and outcomes of patients with this infection at our facility. This is a descriptive case series of patients with NDM-producing Escherichia coli isolated from culture in Detroit between July 2021 and February 2023. Demographics, risk factors, clinical characteristics, management and outcomes were described. Nine patients were included in the study. Most patients were female with a median age of 67 years. Hepatobiliary disease accounted for 90% of underlying conditions. Nearly all patients had prior antibiotic exposure and the most common specimen source was intra-abdominal fluid. Three patients were not treated due to colonisation; among those treated, the majority received trimethoprim-sulfamethoxazole. The median treatment duration and length of stay were 7 and 15.5 days, respectively. Six (67%) patients survived. This report describes a large case series of NDM-producing E. coli infection. Patients with significant comorbidities remain at high risk for CRE infection. Antibiotic options for the treatment of NDM organisms are very limited; new and effective therapies are urgently needed.