Comprehensive clinical and epidemiological assessment of colonisation and infection due to carbapenemase-producing Enterobacteriaceae in Spain
Por:
Palacios-Baena, ZR, Oteo, J, Conejo, C, Larrosa, MN, Bou, G, Fernandez-Martinez, M, Gonzalez-Lopez, JJ, Pintado, V, Martinez-Martinez, L, Merino, M, Pomar, V, Mora-Rillo, M, Rivera, MA, Oliver, A, Ruiz-Carrascoso, G, Ruiz-Garbajosa, P, Zamorano, L, Bautista, V, Ortega, A, Morales, I, Pascual, A, Campos, J, Rodriguez-Bano, J
Publicada:
1 feb 2016
Resumen:
Background: Most available information on carbapenemase-producing Enterobacteriaceae (CPE) is usually associated with specific types of infection or patient or with descriptions of outbreaks. The aim of this study was to comprehensively analyse the clinical epidemiology, clinical features and outcomes of colonisation and infections due to CPE in Spain.
Methods: A multicentre prospective cohort study was carried out in 34 Spanish hospitals from February to May 2013. All new patients testing positive for CPE in clinical samples were included. Logistic regression was used to identify predictors of mortality.
Results: Overall, 245 cases were included. The most frequent organism was Klebsiella pneumoniae (74%) and the carbapenemases belonged to the OXA-48 (74%), metallo-beta-lactamase (MBL) (24%) and KPC (2%) groups. Acquisition was nosocomial in 145 cases (60%) and healthcare- associated (HCA) in 91 (37%); 42% of the latter were nursing home residents, in whom OXA-48-producing K. pneumoniae ST405 predominated. MBLs and OXA-48 predominated in ICU and medical patients, respectively. Overall, 67% of patients had infections. The most frequent infections identified in this study were urinary tract (43%) and skin structure (21%) infections, and 10% of infections were bacteraemic. Crude mortality was 20%. Inappropriate antibiotic therapy was independently associated with an increased risk of death (OR = 3.30; 95% CI: 1.34-8.11).
Conclusions: We found some differences in the epidemiology of CPE depending on the type of carbapenemase produced. Although a low proportion of CPE infections were bacteraemic, active antibiotic therapy was a protective factor for reducing mortality. (C) 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Filiaciones:
Palacios-Baena, ZR:
Hosp Univ Virgen Macarena & Virgen del Rocio, Unidad Gest Clin Interctr Enfermedades Infecciosa, Microbiol & Med Prevent, Seville, Spain
Oteo, J:
Inst Salud Carlos III, Ctr Nacl Microbiol, Bacteriol, Lab Antibiot, Madrid, Spain
Conejo, C:
Hosp Univ Virgen Macarena & Virgen del Rocio, Unidad Gest Clin Interctr Enfermedades Infecciosa, Microbiol & Med Prevent, Seville, Spain
Univ Seville, Dept Microbiol, Seville, Spain
Larrosa, MN:
Univ Autonoma Barcelona, Hosp Vall dHebron, Serv Microbiol, E-08193 Barcelona, Spain
Bou, G:
Complejo Hosp Univ A Coruna, INIBIC, Microbiol Serv, La Coruna, Spain
Fernandez-Martinez, M:
Hosp Univ Marques de Valdecilla, IDIVAL, Microbiol Serv, Santander, Spain
Gonzalez-Lopez, JJ:
Univ Autonoma Barcelona, Hosp Vall dHebron, Serv Microbiol, E-08193 Barcelona, Spain
Pintado, V:
Hosp Univ Ramon & Cajal, Serv Enfermedades Infecciosas, Madrid, Spain
IRYCIS, Madrid, Spain
Martinez-Martinez, L:
Hosp Univ Marques de Valdecilla, IDIVAL, Microbiol Serv, Santander, Spain
Univ Cantabria, Dept Biol Mol, E-39005 Santander, Spain
Merino, M:
Complejo Hosp Univ A Coruna, INIBIC, Microbiol Serv, La Coruna, Spain
Pomar, V:
Hosp Santa Creu & Sant Pau, Inst Invest Biomed St Pau, Serv Microbiol, Barcelona, Spain
Mora-Rillo, M:
Hosp Univ La Paz, IdiPAZ, Unidad Enfermedades Infecciosas & Microbiol Clin, Madrid, Spain
Rivera, MA:
Hosp Santa Creu & Sant Pau, Inst Invest Biomed St Pau, Serv Microbiol, Barcelona, Spain
Oliver, A:
Hosp Son Espases, Inst Invest Sanitaria Palma IdISPa, Serv Microbiol, Palma De Mallorca, Spain
Ruiz-Carrascoso, G:
Hosp Univ La Paz, IdiPAZ, Serv Microbiol, Madrid, Spain
Ruiz-Garbajosa, P:
IRYCIS, Madrid, Spain
Hosp Univ Ramon & Cajal, Serv Microbiol, Madrid, Spain
Zamorano, L:
Hosp Son Espases, Inst Invest Sanitaria Palma IdISPa, Serv Microbiol, Palma De Mallorca, Spain
Bautista, V:
Inst Salud Carlos III, Ctr Nacl Microbiol, Bacteriol, Lab Antibiot, Madrid, Spain
Ortega, A:
Inst Salud Carlos III, Ctr Nacl Microbiol, Bacteriol, Lab Antibiot, Madrid, Spain
Morales, I:
Hosp Univ Virgen Macarena & Virgen del Rocio, Unidad Gest Clin Interctr Enfermedades Infecciosa, Microbiol & Med Prevent, Seville, Spain
Pascual, A:
Hosp Univ Virgen Macarena & Virgen del Rocio, Unidad Gest Clin Interctr Enfermedades Infecciosa, Microbiol & Med Prevent, Seville, Spain
Univ Seville, Dept Microbiol, Seville, Spain
Campos, J:
Inst Salud Carlos III, Ctr Nacl Microbiol, Bacteriol, Lab Antibiot, Madrid, Spain
CSIC, Madrid, Spain
Rodriguez-Bano, J:
Hosp Univ Virgen Macarena & Virgen del Rocio, Unidad Gest Clin Interctr Enfermedades Infecciosa, Microbiol & Med Prevent, Seville, Spain
Univ Seville, Dept Med, Seville, Spain
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