Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain.

Carbapenem resistant Enterobacterales Clinical features KPC-3 OXA-48 Risk factors

Journal

Infection
ISSN: 1439-0973
Titre abrégé: Infection
Pays: Germany
ID NLM: 0365307

Informations de publication

Date de publication:
04 May 2024
Historique:
received: 26 01 2024
accepted: 12 04 2024
medline: 5 5 2024
pubmed: 5 5 2024
entrez: 4 5 2024
Statut: aheadofprint

Résumé

Community-acquired (CA) and healthcare-associated (HCA) infections caused by carbapenemase-producing Enterobacterales (CPE) are not well characterized. The objective was to provide detailed information about the clinical and molecular epidemiological features of nosocomial, HCA and CA infections caused by carbapenemase-producing Klebsiella pneumoniae (CP-Kp) and Escherichia coli (CP-Ec). A prospective cohort study was performed in 59 Spanish hospitals from February to March 2019, including the first 10 consecutive patients from whom CP-Kp or CP-Ec were isolated. Patients were stratified according to acquisition type. A multivariate analysis was performed to identify the impact of acquisition type in 30-day mortality. Overall, 386 patients were included (363 [94%] with CP-Kp and 23 [6%] CP-Ec); in 296 patients (76.3%), the CPE was causing an infection. Acquisition was CA in 31 (8.0%) patients, HCA in 183 (47.4%) and nosocomial in 172 (48.3%). Among patients with a HCA acquisition, 100 (54.6%) had been previously admitted to hospital and 71 (38.8%) were nursing home residents. Urinary tract infections accounted for 19/23 (82.6%), 89/130 (68.5%) and 42/143 (29.4%) of CA, HCA and nosocomial infections, respectively. Overall, 68 infections (23%) were bacteremia (8.7%, 17.7% and 30.1% of CA, HCA and nosocomial, respectively). Mortality in infections was 28% (13%, 14.6% and 42.7% of CA, HCA and nosocomial, respectively). Nosocomial bloodstream infections were associated with increased odds for mortality (adjusted OR, 4.00; 95%CI 1.21-13.19). HCA and CA infections caused by CPE are frequent and clinically significant. This information may be useful for a better understanding of the epidemiology of CPE.

Sections du résumé

BACKGROUND BACKGROUND
Community-acquired (CA) and healthcare-associated (HCA) infections caused by carbapenemase-producing Enterobacterales (CPE) are not well characterized. The objective was to provide detailed information about the clinical and molecular epidemiological features of nosocomial, HCA and CA infections caused by carbapenemase-producing Klebsiella pneumoniae (CP-Kp) and Escherichia coli (CP-Ec).
METHODS METHODS
A prospective cohort study was performed in 59 Spanish hospitals from February to March 2019, including the first 10 consecutive patients from whom CP-Kp or CP-Ec were isolated. Patients were stratified according to acquisition type. A multivariate analysis was performed to identify the impact of acquisition type in 30-day mortality.
RESULTS RESULTS
Overall, 386 patients were included (363 [94%] with CP-Kp and 23 [6%] CP-Ec); in 296 patients (76.3%), the CPE was causing an infection. Acquisition was CA in 31 (8.0%) patients, HCA in 183 (47.4%) and nosocomial in 172 (48.3%). Among patients with a HCA acquisition, 100 (54.6%) had been previously admitted to hospital and 71 (38.8%) were nursing home residents. Urinary tract infections accounted for 19/23 (82.6%), 89/130 (68.5%) and 42/143 (29.4%) of CA, HCA and nosocomial infections, respectively. Overall, 68 infections (23%) were bacteremia (8.7%, 17.7% and 30.1% of CA, HCA and nosocomial, respectively). Mortality in infections was 28% (13%, 14.6% and 42.7% of CA, HCA and nosocomial, respectively). Nosocomial bloodstream infections were associated with increased odds for mortality (adjusted OR, 4.00; 95%CI 1.21-13.19).
CONCLUSIONS CONCLUSIONS
HCA and CA infections caused by CPE are frequent and clinically significant. This information may be useful for a better understanding of the epidemiology of CPE.

Identifiants

DOI: 10.1007/s15010-024-02267-0 PMID: 38703288
pubmed: 38703288
doi: 10.1007/s15010-024-02267-0
pii: 10.1007/s15010-024-02267-0
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Investigateurs

Mariela Martínez Ramírez (M)
M Pilar Ortega Lafont (MP)
Emilia Cercenado (E)
Cristobal Del Rosario (C)
Jose Luis Perez Arellano (JL)
María Lecuona (M)
Luis López-Urrutia Lorente (L)
José Leiva (J)
José Luis Del Pozo (JL)
Salvador Giner (S)
Juan Frasquet (J)
Lidia Garcia Agudo (L)
Soledad Illescas (S)
Pedro de la Iglesia (P)
Rosario Sánchez Benito (R)
Eugenio Garduño (E)
Ma Isabel Fernández Natal (MI)
Marta Arias (M)
Mar Olga Pérez Moreno (MO)
Ana Isabel López-Calleja (AI)
José Manuel Azcona (JM)
Alba Belles (A)
Mercè García González (M)
Miriam Valverde Troya (M)
Begoña Palop (B)
Fernando García Garrote (F)
Jose Luis Barrios Andrés (JL)
Leyre López Soria (L)
Adelina Gimeno (A)
Ester Clapés Sanchez (E)
Jennifer Villa (J)
Nuria Iglesias Nuñez (N)
Rafael Sánchez Arroyo (R)
Susana Hernando (S)
Eva Riquelme Bravo (E)
Caridad Sainz de Baranda (C)
Oscar Esparcia Rodríguez (O)
Jorge Gaitán (J)
María Huertas (M)
M José Rodríguez Escudero (MJ)
Carmen Aldea (C)
Nerea Sanchez (N)
Antonio Casabella Pernas (A)
Ma Dolores Quesada (MD)
Carmina Martí Sala (C)
Laura Mora (L)
Encarnación Clavijo (E)
Natalia Chueca (N)
Federico Juan Manuel GarcíaSánchez (FJM)
Fátima Galán Sánchez (F)
Carmen Liébana (C)
Carolina Roldán (C)
Ma Isabel Cabeza (MI)
Ma Teresa Cabezas Fernández (MT)
Lucía Martínez Lamas (L)
Sonia Rey Cao (S)
Ma Isabel Paz Vidal (MI)
Raquel Elisa Rodríguez Tarazona Y Noelia Arenal Andrés (RERTYNA)
Amparo Coira Nieto (A)
Ma Luisa Pérez Del Molino Bernal (ML)
María Gomáriz Díaz (M)
Matxalen Vidal-García (M)
Jose Luis de Tuesta Díaz (JL)
Moises García Bravo (M)
Almudena Tinajas (A)
Fe Tubau Quintano (FT)
Borja Suberviola Cañas Y Maria Eliecer Cano García (BSCYMEC)
Irene Gracia-Ahufinger (I)
Mónica González Bardanca (M)
Belén Viñado (B)
Xavier Nuvials (X)
Ignasi Roca (I)
Patricia Ruiz-Garbajosa (P)
Desireé Gijon (D)
Vicente Pintado (V)
Alba Rivera (A)
David Gutiérrez Campos (DG)
Aurora Alemán (A)
Ignacio Ayestarán (I)
Andrés Canut Blasco Y Jorge Arribas García (ACBYJA)

Informations de copyright

© 2024. The Author(s).

Références

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Auteurs

Elena Salamanca-Rivera (E)

Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain.
CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.

Zaira R Palacios-Baena (ZR)

Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain. zaira.palacios.baena@hotmail.com.
CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain. zaira.palacios.baena@hotmail.com.

Javier E Cañada (JE)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Laboratorio de Referencia a Antibióticos E Infecciones Relacionadas Con La Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.

Zaira Moure (Z)

Laboratorio de Referencia a Antibióticos E Infecciones Relacionadas Con La Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.

María Pérez-Vázquez (M)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Laboratorio de Referencia a Antibióticos E Infecciones Relacionadas Con La Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.

Jorge Calvo-Montes (J)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.

Luis Martínez-Martínez (L)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Microbiology Unit, Department of Agricultural Chemistry, Soil Science and Microbiology, Reina Sofia University Hospital, University of Córdoba, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.

Rafael Cantón (R)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.

Guillermo Ruiz Carrascoso (G)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Microbiología Clínica, Hospital Universitario La Paz (IdiPAz), Madrid, Spain.

Cristina Pitart (C)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Microbiología, Hospital Clínic de Barcelona, ISGlobal Barcelona Institute for Global Health, Barcelona, Spain.

Ferran Navarro (F)

Servicio de Microbiología, Hospital de La Santa Creu I Sant Pau. Departament de Genètica I de Microbiologia Universitat Autónoma de Barcelona (UAB), Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.

Germán Bou (G)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Servicio Microbiología, Hospital Universitario A Coruña, Instituto Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain.

Xavier Mulet (X)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma, Spain.

Juan José González-López (JJ)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Servei de Microbiologia, Departament de Genetica I Microbiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.

Fran Sivianes (F)

Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain.

Mercedes Delgado-Valverde (M)

Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain.
CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.

Álvaro Pascual (Á)

Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain.
CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.

Jesús Oteo-Iglesias (J)

CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Laboratorio de Referencia a Antibióticos E Infecciones Relacionadas Con La Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.

Jesús Rodríguez-Baño (J)

Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain. jesusrb@us.es.
CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain. jesusrb@us.es.

Classifications MeSH