Article
Author: Arias, Marta ; Quintano, Fe Tubau ; Rey Cao, Sonia ; Cabezas Fernández, Ma Teresa ; Pascual, Álvaro ; Palop, Begoña ; Barrios Andrés, Jose Luis ; Casabella Pernas, Antonio ; Gijon, Desireé ; Cabeza, Ma Isabel ; Azcona, José Manuel ; Perez Arellano, Jose Luis ; Garcia Agudo, Lidia ; Gracia-Ahufinger, Irene ; Sainz de Baranda, Caridad ; de Tuesta Díaz, Jose Luis ; Giner, Salvador ; Hernando, Susana ; Vidal-García, Matxalen ; de la Iglesia, Pedro ; Illescas, Soledad ; Navarro, Ferran ; Martínez Lamas, Lucía ; Rodríguez Escudero, M. José ; Alemán, Aurora ; Gimeno, Adelina ; Pérez del Molino Bernal, Ma Luisa ; Rivera, Alba ; Calvo-Montes, Jorge ; Lecuona, María ; Oteo-Iglesias, Jesús ; Gomáriz Díaz, María ; Sanchez, Nerea ; Fernández Natal, Ma Isabel ; González Bardanca, Mónica ; Martínez-Martínez, Luis ; Rodríguez-Baño, Jesús ; Galán Sánchez, Fátima ; Pitart, Cristina ; Pérez-Vázquez, María ; Frasquet, Juan ; Clavijo, Encarnación ; Coira Nieto, Amparo ; Clapés Sanchez, Ester ; Quesada, Ma Dolores ; Pérez Moreno, Mar Olga ; del Rosario, Cristobal ; Martí Sala, Carmina ; Delgado-Valverde, Mercedes ; Salamanca-Rivera, Elena ; Valverde Troya, Miriam ; Garduño, Eugenio ; Andrés, Raquel Elisa Rodríguez Tarazona y N ; García, Andrés Canut Blasco y Jorge Arribas ; Moure, Zaira ; Mulet, Xavier ; del Pozo, José Luis ; García, Borja Suberviola Cañas y Maria Elie ; Sivianes, Fran ; Iglesias Nuñez, Nuria ; García Bravo, Moises ; Aldea, Carmen ; Palacios-Baena, Zaira R. ; Sánchez Benito, Rosario ; Paz Vidal, Ma Isabel ; Roca, Ignasi ; GarcíaSánchez, Federico Juan Manuel ; Cañada, Javier E. ; López Soria, Leyre ; López-Urrutia Lorente, Luis ; Ruiz-Garbajosa, Patricia ; Campos, David Gutiérrez ; Martínez Ramírez, Mariela ; Riquelme Bravo, Eva ; Cantón, Rafael ; Chueca, Natalia ; Villa, Jennifer ; Ortega Lafont, M. Pilar ; García Garrote, Fernando ; González-López, Juan José ; García González, Mercè ; Nuvials, Xavier ; Roldán, Carolina ; Pintado, Vicente ; Gaitán, Jorge ; Huertas, María ; Ruiz Carrascoso, Guillermo ; Liébana, Carmen ; Ayestarán, Ignacio ; Viñado, Belén ; Sánchez Arroyo, Rafael ; Tinajas, Almudena ; Bou, Germán ; Leiva, José ; Cercenado, Emilia ; Belles, Alba ; Mora, Laura ; Esparcia Rodríguez, Oscar ; López-Calleja, Ana Isabel
AbstractBackgroundCommunity-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).MethodsA 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.ResultsOverall, 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).ConclusionsHCA 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.
