Prevalence of ESBL non-CRE Escherichia coli and Klebsiella pneumoniae among clinical isolates collected by the SMART global surveillance programme from 2015 to 2019

This study aimed to determine the prevalence of extended-spectrum β-lactamase (ESBL) non-carbapenem-resistant Enterobacterales (non-CRE) phenotype among clinical Escherichia coli and Klebsiella pneumoniae isolates collected in 2018–2019 for the SMART global surveillance programme and review trends in prevalence over 5 years (2015–2019). MICs were determined by CLSI reference broth microdilution. ESBL non-CRE phenotypes were defined as non-susceptible to ceftriaxone (MIC ≥ 2 μg/mL) and susceptible to ertapenem (MIC ≤ 0.5 μg/mL). In 2018–2019, ESBL non-CRE phenotypes among E. coli were more common in respiratory tract infection isolates than other infection sources across all global regions; for K. pneumoniae there was wide variation by geographic region in the specimen source most frequently associated with this phenotype. In most regions, ESBL non-CRE phenotype isolates were found more frequently in samples from ICU patients than non-ICU patients and from patients with hospital length of stay at time of specimen collection ≥48 h versus <48 h. ESBL non-CRE phenotypes exceeded 50% of isolates for E. coli from India, Thailand, Vietnam, China, Russia, Mexico, Kenya and Kuwait and for K. pneumoniae from Lithuania and Kuwait. ESBL non-CRE phenotype E. coli increased significantly (P < 0.05) in Asia (excluding China), Australia/New Zealand and Latin America from 2015–2019, while ESBL non-CRE phenotype K. pneumoniae increased significantly in Latin America, USA and Canada. There was marked variability in ESBL rates across countries, over time, and by sample source and ward type. Trending data from 2015–2019 showed ESBL rates are increasing in many regions worldwide.