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