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Carbapenemases (no. isolates) Geographic location (no. isolates) Sequence types (no. isolates)
KPCs (50)    
   KPC-2 (35) Argentina (4), Brazil (5), Colombia (8), Greece (1), Guatemala (4), Israel (2), Puerto Rico (2), United States (4), Venezuela (1), Vietnam (4) ST10 (3), ST46 (2), ST69 (2), ST95 (3), ST131 (7), ST349 (1), ST405 (3), ST410 (3), ST538 (1), ST540 (1), ST607 (1), ST617 (1), ST648 (1), ST1193 (1), ST1196 (1), ST2172 (1), ST2279 (1), ST3580 (1)
   KPC-3 (14) Colombia (1), Israel (1), Italy (8), United States (4) ST12 (1), ST73 (1), ST131 (7), ST141 (1), ST191 (1), ST617 (1), ST973 (1), ST1148 (1)
   KPC-18 (1) United States (1) ST131 (1)
NDMs (66)    
   NDM-1 (19) Egypt (3), Guatemala (2), Kuwait (1), Morocco (4), Philippines (1), Romania (1), Russia (3), Serbia (1), Thailand (2), Vietnam (1) ST38 (1), ST44 (1), ST69 (1), ST95 (1), ST131 (4), ST167 (3), ST345 (1), ST361 (1), ST617 (2), ST1193 (1), ST1434 (1), ST1470 (1), ST4553 (1),
   NDM-4 (1) Vietnam (1) ST405 (1)
   NDM-5 (40) Canada (1), Egypt (16), Italy (2), Jordan (4), Lebanon (1), Thailand (8), United Kingdom (2), Vietnam (6) ST131 (1), ST156 (1), ST167 (11), ST361 (4), ST405 (3), ST410 (12), ST448 (2), ST648 (4), ST2003 (2)
   NDM-6 (1) Guatemala (1) ST38 (1)
   NDM-7 (5) Philippines (4), Vietnam (1) ST156 (2), ST410 (1), ST448 (1), ST5229 (1)
OXA-48–like (96)    
   OXA-48 (40) Austria (1), Belgium (2), Egypt (3), Georgia (3), Israel (1), Lebanon (2), Mexico (1), Morocco (2), Saudi Arabia (1), Spain (2), Thailand (1), Tunisia (1), Turkey (15), United Kingdom (1), Vietnam (4) ST10 (2), ST12 (1), ST34 (1), ST38 (8), ST58 (1), ST131 (2), ST224 (1), ST349 (1), ST354 (6), ST361 (1), ST405 (4), ST410 (2), ST624 (1), ST648 (1), ST1431 (1), ST11260 (6)
   OXA-181 (48) Egypt (6), Germany (1), Jordan (15), Kuwait (1), Lebanon (1), Malaysia (1), South Africa (2), Taiwan (1), Thailand (2), Turkey (18) ST46 (1), ST131 (1), ST167 (2), ST205 (1), ST354 (1), ST410 (21), ST648 (1), ST1284 (18), ST1487 (1), ST6802 (1)
   OXA-232 (5) Malaysia (1), Mexico (3), Thailand (1) ST127 (1), ST131 (1), ST361 (3)
   OXA-244 (3) Egypt (3) ST58 (1), ST648 (1), ST1722 (1)
VIMs (4)    
   VIM-1 (2) Greece (1), Spain (1) ST88 (1), ST404 (1)
   VIM-23 (2) Mexico (2) ST410 (2)
IMPs (2)    
   IMP-59 (2) Australia (2) ST357 (2)
Two carbapenemases (11)    
   NDM-1 + VIM-1 (1) Egypt (1) ST131 (1)
   NDM-1 + OXA-181 (2) Egypt (2) ST46 (2)
   NDM-5 + OXA-48 (1) Egypt (1) ST167 (1)
   NDM-5 + OXA-181 (5) Egypt (3), South Korea (1), Vietnam (1) ST410 (4), ST448 (1)
   NDM-5 + OXA-232 (2) United Kingdom (2) ST2083 (2)

Table. Global molecular epidemiology of 229 carbapenemase-producing Escherichia coli isolates, 36 countries, 2015–2017*

*KPC, Klebsiella pneumoniae carbapenemase; NDM, New Delhi metallo-β-lactamase; OXA, oxacillinase; ST, sequence type ; VIM, Verona integron‒encoded metallo-β-lactamase.


Genomic Epidemiology of Global Carbapenemase-Producing Escherichia coli, 2015–2017

  • Authors: Gisele Peirano, PhD; Liang Chen, PhD; Diego Nobrega, PhD; Thomas J. Finn, PhD; Barry N. Kreiswirth, PhD; Rebekah DeVinney, PhD; Johann D. D. Pitout, MD
  • CME / ABIM MOC Released: 4/15/2022
  • Valid for credit through: 4/15/2023
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Target Audience and Goal Statement

This activity is intended for infectious disease clinicians, epidemiologists, public health officials, geneticists, internists, and other clinicians who treat and manage patients with or at risk for carbapenemase-producing Escherichia coli.

The goal of this activity is to describe the geographic distribution of different carbapenemase genes (including associations with dominant sequence types, clades, and underlying mobile genetic elements), other β-lactamases, antibiotic resistance genes, and virulence factors, based on short read whole genome sequencing of 229 carbapenemase-producing Escherichia coli (2015-17) from 36 countries (including 20 lower- and middle-income countries).

Upon completion of this activity, participants will:

  • Assess the global distribution of different carbapenemase genes, based on a genome sequencing study of 229 carbapenemase-producing Escherichia coli (2015-17) from 36 countries
  • Evaluate antimicrobial resistance determinants and plasmid replicon types, virulence-associated factors, and carbapenemase gene flanking regions and plasmid analysis, based on a genome sequencing study of 229 carbapenemase-producing Escherichia coli (2015-17) from 36 countries
  • Determine the public health implications of the global distribution of different carbapenemase genes and associated factors, based on a genome sequencing study of 229 carbapenemase-producing Escherichia coli (2015-17) from 36 countries


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  • Gisele Peirano, PhD

    University of Calgary, Calgary, Alberta, Canada; Alberta Precision Laboratories, Calgary, Alberta, Canada

  • Liang Chen, PhD

    Hackensack Meridian School of Medicine, Nutley, New Jersey, USA

  • Diego Nobrega, PhD

    University of Guelph, Guelph, Ontario, Canada

  • Thomas J. Finn, PhD

    University of Calgary, Calgary, Alberta, Canada

  • Barry N. Kreiswirth, PhD

    Hackensack Meridian School of Medicine, Nutley, New Jersey, USA

  • Rebekah DeVinney, PhD

    University of Calgary, Calgary, Alberta, Canada

  • Johann D. D. Pitout, MD

    University of Calgary, Calgary, Alberta, Canada; Alberta Precision Laboratories, Calgary, Alberta, Canada; University of Pretoria, Pretoria, Gauteng, South Africa

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC


    Disclosure: Laurie Barclay, MD, has disclosed the following relevant financial relationships:
    Stocks, stock options, or bonds: AbbVie (former)


  • Jude Rutledge, BA

    Emerging Infectious Diseases


    Disclosure: Jude Rutledge, BA, has disclosed no relevant financial relationships.

Compliance Reviewer

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC


    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.

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Genomic Epidemiology of Global Carbapenemase-Producing Escherichia coli, 2015–2017

Authors: Gisele Peirano, PhD; Liang Chen, PhD; Diego Nobrega, PhD; Thomas J. Finn, PhD; Barry N. Kreiswirth, PhD; Rebekah DeVinney, PhD; Johann D. D. Pitout, MDFaculty and Disclosures

CME / ABIM MOC Released: 4/15/2022

Valid for credit through: 4/15/2023



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