Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain
Por:
Salamanca-Rivera, E, Palacios-Baena, ZR, Cañada, JE, Moure, Z, Pérez-Vázquez, M, Calvo-Montes, J, Martínez-Martínez, L, Cantón, R, Carrascoso, GR, Pitart, C, Navarro, F, Bou, G, Mulet, X, González-López, JJ, Sivianes, F, Delgado-Valverde, M, Pascual, A, Oteo-Iglesias, J, Rodríguez-Baño, J
Publicada:
4 may 2024
Ahead of Print:
1 may 2024
Resumen:
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 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 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 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.
Filiaciones:
Salamanca-Rivera, E:
Univ Seville, Inst Biomed Sevilla IBiS,CSIC, Hosp Univ Virgen Macarena, Unidad Gest Clin Enfermedades Infecciosas Microbi, Ave Dr Fedriani 3, Seville 41009, Spain
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Palacios-Baena, ZR:
Univ Seville, Inst Biomed Sevilla IBiS,CSIC, Hosp Univ Virgen Macarena, Unidad Gest Clin Enfermedades Infecciosas Microbi, Ave Dr Fedriani 3, Seville 41009, Spain
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Cañada, JE:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Inst Salud Carlos III, Ctr Nacl Microbiol, Lab Referencia Antibioticos & Infecc Relacionadas, Madrid, Spain
Moure, Z:
Inst Salud Carlos III, Ctr Nacl Microbiol, Lab Referencia Antibioticos & Infecc Relacionadas, Madrid, Spain
Hosp Univ Marques Valdecilla, Serv Microbiol, IDIVAL, Santander, Spain
Pérez-Vázquez, M:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Inst Salud Carlos III, Ctr Nacl Microbiol, Lab Referencia Antibioticos & Infecc Relacionadas, Madrid, Spain
Calvo-Montes, J:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Hosp Univ Marques Valdecilla, Serv Microbiol, IDIVAL, Santander, Spain
Martínez-Martínez, L:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Univ Cordoba, Maimonides Biomed Res Inst Cordoba IMIBIC, Microbiol Unit,Reina Sofia Univ Hosp, Dept Agr Chem Soil Sci & Microbiol, Cordoba, Spain
Cantón, R:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Inst Ramon & Cajal Invest Sanitaria IRYCIS, Serv Microbiol, Hosp Univ Ramon & Cajal, Madrid, Spain
Carrascoso, GR:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Hosp Univ La Paz IdiPAz, Serv Microbiol Clin, Madrid, Spain
Pitart, C:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Hosp Clin Barcelona, ISGlobal Barcelona Inst Global Hlth, Serv Microbiol, Barcelona, Spain
Navarro, F:
Univ Autonoma Barcelona, Serv Microbiol,St Pau Biomed Res Inst IIB St Pa, Hosp Santa Creu & St Pau, Dept Genet & Microbiol, Barcelona, Spain
Bou, G:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Hosp Univ A Coruna, Serv Microbiol, Inst Invest Biomed A Coruna INIBIC, La Coruna, Spain
Mulet, X:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Hosp Univ Son Espases, Inst Invest Sanitaria Illes Balears IdISBa, Serv Microbiol, Palma De Mallorca, Spain
González-López, JJ:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Serv Microbiol, Dept Genet & Microbiol, Barcelona, Spain
Sivianes, F:
Univ Seville, Inst Biomed Sevilla IBiS,CSIC, Hosp Univ Virgen Macarena, Unidad Gest Clin Enfermedades Infecciosas Microbi, Ave Dr Fedriani 3, Seville 41009, Spain
Delgado-Valverde, M:
Univ Seville, Inst Biomed Sevilla IBiS,CSIC, Hosp Univ Virgen Macarena, Unidad Gest Clin Enfermedades Infecciosas Microbi, Ave Dr Fedriani 3, Seville 41009, Spain
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Pascual, A:
Univ Seville, Inst Biomed Sevilla IBiS,CSIC, Hosp Univ Virgen Macarena, Unidad Gest Clin Enfermedades Infecciosas Microbi, Ave Dr Fedriani 3, Seville 41009, Spain
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Oteo-Iglesias, J:
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Inst Salud Carlos III, Ctr Nacl Microbiol, Lab Referencia Antibioticos & Infecc Relacionadas, Madrid, Spain
Rodríguez-Baño, J:
Univ Seville, Inst Biomed Sevilla IBiS,CSIC, Hosp Univ Virgen Macarena, Unidad Gest Clin Enfermedades Infecciosas Microbi, Ave Dr Fedriani 3, Seville 41009, Spain
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
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