TY - JOUR T1 - Piperacillin/tazobactam resistant, cephalosporin susceptible <em>Escherichia coli</em> bloodstream infections driven by multiple resistance mechanisms across diverse sequence types JF - bioRxiv DO - 10.1101/2020.09.18.302992 SP - 2020.09.18.302992 AU - Thomas Edwards AU - Eva Heinz AU - Jon van Aartsen AU - Alex Howard AU - Paul Roberts AU - Caroline Corless AU - Alice J. Fraser AU - Christopher T. Williams AU - Issra Bulgasim AU - Luis E. Cuevas AU - Christopher M. Parry AU - Adam P. Roberts AU - Emily R. Adams AU - Jenifer Mason AU - Alasdair T. M. Hubbard Y1 - 2020/01/01 UR - http://biorxiv.org/content/early/2020/09/18/2020.09.18.302992.abstract N2 - Resistance to piperacillin/tazobactam in Escherichia coli is usually mediated by mechanisms providing resistance to 3rd generation cephalosporins, such as extended-spectrum β-lactamases and carbapenemases. Recent reports have identified E. coli strains with resistance to piperacillin/tazobactam but susceptibility to 3rd generation cephalosporins, achieved through hyperproduction of penicillinases, but the genetic diversity of this phenotype and the diversity of resistance mechanisms are unknown. We analysed the genomes of 63 clinical isolates of E. coli with this phenotype, isolated between 2014-2017 at a single tertiary hospital in Liverpool, UK. The phenotype was displayed in a broad range of sequence types which, after comparison with a UK-wide collection, reflected the overall diversity of E. coli clinical isolates. Resistance mechanisms were also diverse, and included predicted hyperproduction of penicillinases, either via strong promoters or gene amplification, carriage of inhibitor resistant β-lactamases, and an S133G blaCTX-M-15 mutation detected for the first time in clinical isolates.Competing Interest StatementThe authors have declared no competing interest. ER -