Molecular epidemiology of β-lactamases in ceftriaxone-resistant Enterobacterales bloodstream infections in the mid-Atlantic United States

Ceftriaxone-resistant Enterobacterales remain a public health threat; contemporary data investigating their molecular epidemiology are limited. Five hundred consecutive ceftriaxone-resistant (MIC ≥ 4 µg/mL) Enterobacterales bloodstream isolates were collected between 2018 and 2022 from three Marylan...

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Published in:Antimicrobial agents and chemotherapy 2025-01, p.e0125824
Main Authors: Hareza, Dariusz A, Bergman, Yehudit, Jacobs, Emily, Lu, Jennifer, Hanson, Nancy D, Conzemius, Rick, Cosgrove, Sara E, Harris, Anthony D, Simner, Patricia J, Tamma, Pranita D
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creator Hareza, Dariusz A
Bergman, Yehudit
Jacobs, Emily
Lu, Jennifer
Hanson, Nancy D
Conzemius, Rick
Cosgrove, Sara E
Harris, Anthony D
Simner, Patricia J
Tamma, Pranita D
description Ceftriaxone-resistant Enterobacterales remain a public health threat; contemporary data investigating their molecular epidemiology are limited. Five hundred consecutive ceftriaxone-resistant (MIC ≥ 4 µg/mL) Enterobacterales bloodstream isolates were collected between 2018 and 2022 from three Maryland hospitals. Broth microdilution confirmed antibiotic susceptibilities. Whole-genome sequencing identified extended-spectrum β-lactamase (ESBL) and genes both in bacterial chromosomes (c- ) and on plasmids (p- ). Mutations in promoter or attenuator regions of the c- gene (i.e., gene) with the potential to result in derepression were investigated. The presence of ESBL or genes was confirmed in 497 (99.4%) isolates. Two hundred seventy-nine (55.8%) isolates had both ESBL and genes. ESBL families were identified among 398 (80%) patients: ( = 370), ( = 17), ( = 14), and ( = 5). Ceftriaxone-resistant Enterobacterales species carrying ESBL genes included the following: (67%), (24%), (4%), (2%), complex (2%), (1%), (
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Five hundred consecutive ceftriaxone-resistant (MIC ≥ 4 µg/mL) Enterobacterales bloodstream isolates were collected between 2018 and 2022 from three Maryland hospitals. Broth microdilution confirmed antibiotic susceptibilities. Whole-genome sequencing identified extended-spectrum β-lactamase (ESBL) and genes both in bacterial chromosomes (c- ) and on plasmids (p- ). Mutations in promoter or attenuator regions of the c- gene (i.e., gene) with the potential to result in derepression were investigated. The presence of ESBL or genes was confirmed in 497 (99.4%) isolates. Two hundred seventy-nine (55.8%) isolates had both ESBL and genes. ESBL families were identified among 398 (80%) patients: ( = 370), ( = 17), ( = 14), and ( = 5). Ceftriaxone-resistant Enterobacterales species carrying ESBL genes included the following: (67%), (24%), (4%), (2%), complex (2%), (1%), (&lt;1%), and (&lt;1%). c- genes were identified in 374 (75%) of the 500 isolates. Only 7% of isolates with mutations in the promoter or attenuator region of the c- gene exhibited resistance to cefoxitin, a proxy for increased AmpC production. Two p- genes were confirmed in 25 (5%) of the 500 isolates: (72%) and (28%; confined to [92%] and [8%]). Until comprehensive β-lactamase molecular testing is available, the species-specific prevalence of ESBL and genes in ceftriaxone-resistant Enterobacterales should be considered to promote effective albeit judicious antibiotic prescribing. 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title Molecular epidemiology of β-lactamases in ceftriaxone-resistant Enterobacterales bloodstream infections in the mid-Atlantic United States
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