Prospective Multicenter Study of Carbapenemase-Producing Enterobacteriaceae from 83 Hospitals in Spain Reveals HighIn VitroSusceptibility to Colistin and Meropenem

Abstract

ABSTRACTThe aim of this study was to determine the impact of carbapenemase-producingEnterobacteriaceae(CPE) in Spain in 2013 by describing the prevalence, dissemination, and geographic distribution of CPE clones, and their population structure and antibiotic susceptibility. From February 2013 to May 2013, 83 hospitals (about 40,000 hospital beds) prospectively collected nonduplicateEnterobacteriaceaeusing the screening cutoff recommended by EUCAST. Carbapenemase characterization was performed by phenotypic methods and confirmed by PCR and sequencing. Multilocus sequencing types (MLST) were determined forKlebsiella pneumoniaeandEscherichia coli. A total of 702Enterobacteriaceaeisolates met the inclusion criteria; 379 (54%) were CPE. OXA-48 (71.5%) and VIM-1 (25.3%) were the most frequent carbapenemases, andK. pneumoniae(74.4%),Enterobacter cloacae(10.3%), andE. coli(8.4%) were the species most affected. Susceptibility to colistin, amikacin, and meropenem was 95.5%, 81.3%, and 74.7%, respectively. The most prevalent sequence types (STs) were ST11 and ST405 forK. pneumoniaeand ST131 forE. coli. Forty-five (54.1%) of the hospitals had at least one CPE case. ForK. pneumoniae, ST11/OXA-48, ST15/OXA-48, ST405/OXA-48, and ST11/VIM-1 were detected in two or more Spanish provinces. ST11 isolates carried four carbapenemases (VIM-1, OXA-48, KPC-2, and OXA-245), but ST405 isolates carried OXA-48 only. A wide interregional spread of CPE in Spain was observed, mainly due to a few successful clones of OXA-48-producingK. pneumoniae(e.g., ST11 and ST405). The dissemination of OXA-48-producingE. coliis a new finding of public health concern. According to the susceptibilities determinedin vitro, most of the CPE (94.5%) had three or more options for antibiotic treatment.