Emergence of carbapenemase-producing Escherichia coli in acute care hospitals in 32 European countries (the CCRE survey): a prospective, multicentre, cross-sectional, epidemiological, microbiological, and genomic surveillance study

@article{david2026emergence,
  title = {{Emergence of carbapenemase-producing Escherichia coli in acute care hospitals in 32 European countries (the CCRE survey): a prospective, multicentre, cross-sectional, epidemiological, microbiological, and genomic surveillance study}},
  author = {Sophia David and Anke Kohlenberg and Corin Yeats and Khalil Abudahab and Barbara Albiger and Nabil-Fareed Alikhan and Erik Alm and Sara Byfors and Natacha Couto and Julio Diaz Caballero and Christian G. Giske and Corinna Glasner and Marius Linkevičius and Erika Matuschek and Daniel Palm and Olov Svartström and Hajo Grundmann and Marc Jean Struelens and Karin Tegmark Wisell and Dominique L. Monnet and Inga Fröding and David M. Aanensen and Alma Brolund and Andi Koraqi and Artan Bego and Petra Apfalter and Rainer Hartl and Te-Din Huang and Katrien Latour and Maja Travar and Stefana Sabtcheva and Arjana Tambić-Andrašević and Jaroslav Hrabák and Helena Žemličková and Panayiota Maikanti-Charalambous and Anette Marie Hammerum and Anastasia Bilozor and Marika Jürna‐Ellam and Jari Jalava and Kati Räisänen and Laurent Dortet and Ines Noll and Niels Pfennigwerth and Kyriaki Tryfinopoulou and Alkiviadis C. Vatopoulos and Ákos Tóth and Kristján Orri Helgason and Martin Cormican and María Del Grosso and Maria Giufrè and Arsim Kurti and Lul Raka and Baiba Niedre-Otomere and Jelena Razmuk and Jekaterina Sinotova and Marie Meo and Monique Perrin and Denise Micallef and Nina Nestorova and Milena Lopičić},
  journal = {The Lancet Microbe},
  year = {2026},
  month = may,
  doi = {10.1016/j.lanmic.2025.101321},
  url = {https://doi.org/10.1016/j.lanmic.2025.101321},
  note = {CC BY},
}

TY  - JOUR
TI  - Emergence of carbapenemase-producing Escherichia coli in acute care hospitals in 32 European countries (the CCRE survey): a prospective, multicentre, cross-sectional, epidemiological, microbiological, and genomic surveillance study
AU  - Sophia David
AU  - Anke Kohlenberg
AU  - Corin Yeats
AU  - Khalil Abudahab
AU  - Barbara Albiger
AU  - Nabil-Fareed Alikhan
AU  - Erik Alm
AU  - Sara Byfors
AU  - Natacha Couto
AU  - Julio Diaz Caballero
AU  - Christian G. Giske
AU  - Corinna Glasner
AU  - Marius Linkevičius
AU  - Erika Matuschek
AU  - Daniel Palm
AU  - Olov Svartström
AU  - Hajo Grundmann
AU  - Marc Jean Struelens
AU  - Karin Tegmark Wisell
AU  - Dominique L. Monnet
AU  - Inga Fröding
AU  - David M. Aanensen
AU  - Alma Brolund
AU  - Andi Koraqi
AU  - Artan Bego
AU  - Petra Apfalter
AU  - Rainer Hartl
AU  - Te-Din Huang
AU  - Katrien Latour
AU  - Maja Travar
AU  - Stefana Sabtcheva
AU  - Arjana Tambić-Andrašević
AU  - Jaroslav Hrabák
AU  - Helena Žemličková
AU  - Panayiota Maikanti-Charalambous
AU  - Anette Marie Hammerum
AU  - Anastasia Bilozor
AU  - Marika Jürna‐Ellam
AU  - Jari Jalava
AU  - Kati Räisänen
AU  - Laurent Dortet
AU  - Ines Noll
AU  - Niels Pfennigwerth
AU  - Kyriaki Tryfinopoulou
AU  - Alkiviadis C. Vatopoulos
AU  - Ákos Tóth
AU  - Kristján Orri Helgason
AU  - Martin Cormican
AU  - María Del Grosso
AU  - Maria Giufrè
AU  - Arsim Kurti
AU  - Lul Raka
AU  - Baiba Niedre-Otomere
AU  - Jelena Razmuk
AU  - Jekaterina Sinotova
AU  - Marie Meo
AU  - Monique Perrin
AU  - Denise Micallef
AU  - Nina Nestorova
AU  - Milena Lopičić
PY  - 2026
DA  - 2026/05/14
JO  - The Lancet Microbe
DO  - 10.1016/j.lanmic.2025.101321
UR  - https://doi.org/10.1016/j.lanmic.2025.101321
AB  - Background The emergence of carbapenem resistance in Escherichia coli is of major concern due to the high propensity of spread of this species and scarce treatment options. Herein, we examined the occurrence and spread of carbapenem-resistant E coli based on the carbapenem-resistant and/or colistin-resistant Enterobacterales (CCRE) survey performed across European countries in 2019. Methods We analysed epidemiological, microbiological, and whole-genome sequencing data of 548 E coli isolates from individual patients from 156 hospitals in 32 European countries over 6 months in 2019. These hospitals collected the first ten successive isolates of carbapenem-resistant or carbapenem-susceptible increased exposure (carbapenem-R/I) Klebsiella pneumoniae species complex or E coli, and carbapenem-susceptible (carbapenem-S) comparator isolates of the same species. Antimicrobial susceptibility testing was performed for 19 antimicrobial agents. Whole-genome sequencing was performed centrally using Illumina technology. Isolates from the CCRE survey were compared with those from the European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) study. Findings Of the 548 E coli isolates, 211 (38·5%) were carbapenem-resistant or susceptible, increased exposure (carbapenem-R/I), and 337 (61·5%) were carbapenem-susceptible (carbapenem-S). Five sequence types (STs) accounted for 96 (45·5%) of 211 carbapenem-R/I isolates: ST131 (27), ST410 (20), ST38 (19), ST167 (16), and ST648 (14). Carbapenemase genes were identified in 182 (86·3%) carbapenem-R/I isolates, a pronounced increase from the 2013–14 EuSCAPE study (36 of 99, 36·4%). The most common genes were bla NDM−5 (62 of 182, 34·1%) and bla OXA−48 (40 of 182, 22·0%). bla NDM−5 carriage increased substantially compared with that in EuSCAPE (two of 99, 2·02%). Phylogenetic analysis showed substantial clonal spread of globally disseminated bla NDM−5 -harbouring lineages, with numerous introductions into Europe but minimal onward transmission. Interpretation High-risk STs of E coli carrying carbapenemase genes are rapidly spreading globally, although our results indicate that, in 2019, most cases in Europe were sporadic. We urge vigilant monitoring, including genomic surveillance, and strengthening of control efforts, to reduce mortality and morbidity associated with the impending rise in carbapenem-R/I E coli cases. Funding European Centre for Disease Prevention and Control and the Centre for Genomic Pathogen Surveillance.
SN  - 2666-5247
ER  -