The emergence of carbapenem-resistant (CR) Escherichia coli obliges an assessment of such strains’ molecular epidemiology. Accordingly, we characterized in detail a globally distributed collection of CR E. coli isolates, then explored for associations between geographical origin and bacterial traits, and between different bacterial traits. We used established PCR-based assays and broth microdilution MIC determinations to characterize 343 global CR (i.e., non-susceptible to ≥ 1 carbapenem) extraintestinal E. coli isolates (2002–2017) for diverse molecular traits—including phylogroups, sequence types (STs), beta-lactamase genes, and 51 virulence genes—and susceptibility to 12 relevant antimicrobial agents. The study population was tremendously diverse according to all assessed variables. Nonetheless, certain geographically aligned, unifying themes emerged. These included an association of an Asia/West Pacific origin with non-B2/D/F phylogroups and STs, lower molecularly inferred virulence, more extensive resistance, and specific resistance genes (notably, metallo-beta-lactamases). Likewise, U.S. isolates from the central region, vs. other regions, were more virulent-appearing and more often from phylogroup B2 and ST131, but less extensively resistant and more often carbapenemase-gene negative. The global CR E. coli population is highly diverse according to multiple characteristics and varies significantly by geographical region. This predictably will pose challenges for prevention and management, and obliges ongoing surveillance.

碳青霉烯类耐药 (CR)大肠杆菌的出现需要对此类菌株的分子流行病学进行评估。因此，我们详细描述了全球分布的 CR大肠杆菌分离株的特征，然后探索地理起源与细菌性状之间以及不同细菌性状之间的关联。我们使用既定的基于 PCR 的测定和肉汤微量稀释 MIC 测定来表征 343 个整体 CR（即对 ≥ 1 种碳青霉烯类不敏感）肠外大肠杆菌分离株（2002-2017 年）的不同分子特征，包括系统发育群、序列类型 (ST) ）、β-内酰胺酶基因和 51 个毒力基因，以及对 12 种相关抗菌药物的敏感性。根据所有评估变量，研究人群非常多样化。尽管如此，某些地理上一致的、统一的主题还是出现了。其中包括亚洲/西太平洋起源与非 B2/D/F 系统群和 ST 的关联、较低的分子推断毒力、更广泛的耐药性和特异性耐药基因（特别是金属-β-内酰胺酶）。同样，与其他地区相比，来自中部地区的美国分离株毒性更强，更常见的是来自系统群 B2 和 ST131，但耐药性较弱，且更常见的是碳青霉烯酶基因阴性。全球 CR大肠杆菌种群具有高度多样性，具有多种特征，并且因地理区域而异。可以预见，这将为预防和管理带来挑战，并需要持续监测。