Comprehensive clinical and epidemiological assessment of colonisation and infection due to carbapenemase-producing Enterobacteriaceae in Spain

Zaira R. Palacios-Baena, Jesús Oteo, Carmen Conejo, M. Nieves Larrosa, Germán Bou, Marta Fernández-Martínez, Juan José González-López, Vicente Pintado, Luis Martínez-Martínez, María Merino, Virginia Pomar, Marta Mora-Rillo, María Alba Rivera, Antonio Oliver, Guillermo Ruiz-Carrascoso, Patricia Ruiz-Garbajosa, Laura Zamorano, Verónica Bautista, Adriana Ortega, Isabel MoralesÁlvaro Pascual, José Campos, Jesús Rodríguez-Baño, Ángel Zaballos, Rafael Cantón, Laura Martínez-García, Ana María Fleites, Carlos Rodríguez-Lucas, Ma Isabel Sánchez-Romero, Luisa García-Picazo, Esteban Aznar, Carolina Campelo, Alejandro González-Praetorius, Sonia Solís, Salvador Giner, Miguel Salavert, Juan Manuel Hernández, Josep Vilaró Pujals, Anna Vilamala Bastarras, Ma Ángeles Orellana, Emilia Cercenado, Mateu Espasa, Dionisia Fontanals, Ma Victoria García-López, José Luis Hernández-Almaraz, Carmina Martí-Sala, Adelina Gimeno, Teresa Alarcón, Laura Llorca, Concepción Segura, Raquel Clivillé-Abad, Montse Motjé, Delia Garcia i Parés, Pedro de laIglesia, Beatriz Iglesias, Juanjo Castón, María Dolores Romero, José Antonio Rodríguez-Polo, Gloria Trujillo, Montserrat Morta, Alberto Gil Setas, Carmen Ezpeleta, Ma Dolores Miguel-Martínez, Antonio Sánchez-Porto, Javier Casas, David Molina, Eugenio Garduño, Juan Carlos Alados, Pepa Pérez-Jové, Goretti Sauca, Carmen Gallés, Fátima Galánand, Francisca Guerrero, Ma Fe Brezmes, Ma Pilar Ortega, Francisco Javier Castillo, Cristina Seral, Alberto Delgado-Iribarren, Alberto Yagüe, Carmen Aspiroz, Ma Isabel Fernández-Natal, Isabel Wilhelmi, Pilar Reyes, Ma Dolores Pérez-Ramírez, Inocente Cuesta, Mar Olga Pérez Moreno, Amparo García, Frederic Ballester, Isabel Pujol, Montserrat Sierra, Araceli González-Cuevas, Pilar López García, Lluís Carbó Saladrigas, Jesús Martínez-López, Lucía Martí-nez-Lamas, Jorge Julio Cabrera, Susana García de Cruz, Carmen Raya, Ana Belén Campo, Inés de Benito

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Abstract

© 2015 The British Infection Association. 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-β-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.
Original languageEnglish
Pages (from-to)152-160
JournalJournal of Infection
Volume72
Issue number2
DOIs
Publication statusPublished - 1 Feb 2016

Keywords

  • Carbapenem resistant Enterobacteriaceae
  • Clinical features
  • Geographic distribution
  • Risk factors

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    Palacios-Baena, Z. R., Oteo, J., Conejo, C., Larrosa, M. N., Bou, G., Fernández-Martínez, M., González-López, J. J., Pintado, V., Martínez-Martínez, L., Merino, M., Pomar, V., Mora-Rillo, M., Rivera, M. A., Oliver, A., Ruiz-Carrascoso, G., Ruiz-Garbajosa, P., Zamorano, L., Bautista, V., Ortega, A., ... de Benito, I. (2016). Comprehensive clinical and epidemiological assessment of colonisation and infection due to carbapenemase-producing Enterobacteriaceae in Spain. Journal of Infection, 72(2), 152-160. https://doi.org/10.1016/j.jinf.2015.10.008