# Bloodstream Infections Due to Carbapenemase-Producing Escherichia coli: A Comprehensive Review

## TL;DR

This review discusses the growing threat of bloodstream infections caused by antibiotic-resistant Escherichia coli and highlights the need for better surveillance and treatment strategies.

## Contribution

The paper provides a comprehensive overview of the global spread, molecular features, and clinical impact of carbapenemase-producing Escherichia coli.

## Key findings

- Carbapenemase-producing Escherichia coli (CP-Ec) is increasingly linked to severe bloodstream infections with limited treatment options.
- Key high-risk clones like ST410, ST167, and ST131 are driving the international spread of CP-Ec.
- NDM-producing CP-Ec is particularly concerning due to its association with treatment failures and poor clinical outcomes.

## Abstract

Background/Objectives: Carbapenemase-producing Escherichia coli (CP-Ec) has emerged as an important contributor to the global crisis of antimicrobial resistance. Although less prevalent than carbapenemase-producing Klebsiella pneumoniae, CP-Ec exhibits marked genomic plasticity, efficient plasmid-mediated dissemination, and increasing involvement in bloodstream infections. This comprehensive review summarizes the global epidemiology, molecular features, treatment options, clonal structure and transmission dynamics of CP-Ec. Particular attention is given to the expanding repertoire of NDM, OXA-48-like, and KPC carbapenemases and their associated plasmid backbones. Key high-risk clones, including ST410, ST167 and ST131, are highlighted as drivers of international spread. Conclusions and Future Directions: CP-Ec bloodstream infections represent a growing clinical challenge, often associated with severe outcomes and limited therapeutic options, particularly for NDM producers. The emergence of treatment failures with last-resort agents further underscores the need for improved management strategies. Strengthened global surveillance, integration of genomic epidemiology, optimized antimicrobial stewardship, and targeted infection control measures are essential to limit the dissemination of CP-Ec and mitigate its impact on human health.