학술논문
Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain.
Document Type
Academic Journal
Author
Salamanca-Rivera E; Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain.; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Palacios-Baena ZR; Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain. zpalacios@us.es.; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain. zpalacios@us.es.; Cañada JE; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Laboratorio de Referencia a Antibióticos E Infecciones Relacionadas Con La Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.; Moure Z; Laboratorio de Referencia a Antibióticos E Infecciones Relacionadas Con La Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.; Pérez-Vázquez M; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Laboratorio de Referencia a Antibióticos E Infecciones Relacionadas Con La Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.; Calvo-Montes J; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.; Martínez-Martínez L; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Microbiology Unit, Department of Agricultural Chemistry, Soil Science and Microbiology, Reina Sofia University Hospital, University of Córdoba, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.; Cantón R; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.; Ruiz Carrascoso G; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Microbiología Clínica, Hospital Universitario La Paz (IdiPAz), Madrid, Spain.; Pitart C; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Microbiología, Hospital Clínic de Barcelona, ISGlobal Barcelona Institute for Global Health, Barcelona, Spain.; Navarro F; Servicio de Microbiología, Hospital de La Santa Creu I Sant Pau. Departament de Genètica I de Microbiologia Universitat Autónoma de Barcelona (UAB), Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.; Bou G; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Servicio Microbiología, Hospital Universitario A Coruña, Instituto Investigación Biomédica A Coruña (INIBIC), A Coruña, Spain.; Mulet X; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma, Spain.; González-López JJ; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Servei de Microbiologia, Departament de Genetica I Microbiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.; Sivianes F; Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain.; Delgado-Valverde M; Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain.; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Pascual Á; Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain.; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Oteo-Iglesias J; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.; Laboratorio de Referencia a Antibióticos E Infecciones Relacionadas Con La Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.; Rodríguez-Baño J; Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain. jesusrb@us.es.; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain. jesusrb@us.es.
Source
Publisher: Springer Heidelberg Country of Publication: Germany NLM ID: 0365307 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1439-0973 (Electronic) Linking ISSN: 03008126 NLM ISO Abbreviation: Infection Subsets: MEDLINE
Subject
Language
English
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.
(© 2024. The Author(s).)
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.
(© 2024. The Author(s).)