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oai:recercat.cat:11351/123402025-10-24T10:24:14Zcom_2072_378070com_2072_378040col_2072_378092

Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain Palacios-Baena, Zaira R. MOURE GARCIA, ZAIRA Perez-Vazquez, Maria Calvo, Jorge Salamanca-Rivera, Elena Cañada-Garcia, Javier E. González-López, Juan José Institut Català de la Salut [Salamanca Rivera E, 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, Sevilla, Spain. CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain. [Cañada JE, 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. [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. [Calvo Montes J] CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain. Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. [González López JJ] CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain. Servei de Microbiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Departament de Genètica I Microbiologia Universitat Autònoma de Barcelona, Bellaterra, Spain Vall d'Hebron Barcelona Hospital Campus Infeccions per escheríchia coli - Epidemiologia Enterobacteriàcies Beta-lactamases Pneumònia adquirida a la comunitat Infeccions nosocomials DISEASES::Bacterial Infections and Mycoses::Infection::Community-Acquired Infections DISEASES::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Enterobacteriaceae Infections::Escherichia coli Infections DISEASES::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Enterobacteriaceae Infections::Klebsiella Infections CHEMICALS AND DRUGS::Enzymes and Coenzymes::Enzymes::Hydrolases::Amidohydrolases::beta-Lactamases ENFERMEDADES::infecciones bacterianas y micosis::infección::infecciones adquiridas en la comunidad ENFERMEDADES::infecciones bacterianas y micosis::infecciones bacterianas::infecciones por bacterias gramnegativas::infecciones por Enterobacteriaceae::infecciones por Escherichia coli ENFERMEDADES::infecciones bacterianas y micosis::infecciones bacterianas::infecciones por bacterias gramnegativas::infecciones por Enterobacteriaceae::infecciones por Klebsiella COMPUESTOS QUÍMICOS Y DROGAS::enzimas y coenzimas::enzimas::hidrolasas::amidohidrolasas::beta-lactamasas Carbapenem resistant enterobacterales; Clinical features; Risk factors Enterobacterales resistentes a carbapenémicos; Características clínicas; Factores de riesgo Enterobacterales resistents a carbapenems; Característiques clíniques; Factors de risc 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. Funding for open access publishing: Universidad de Sevilla/CBUA. This study was supported by grants from the Instituto de Salud Carlos III (Ministerio de Ciencia e Innovación): grant PI21CIII/00039 and Personalized and precision medicine grant (MePRAM project, PMP22/00092 funded by NextGeneration EU funds. It was also supported by Plan Nacional de I + D + i 2013–2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía y Competitividad, Spanish Network for Research in Infectious Diseases (grants RD16CIII/0004/0002, RD16/0016/0001, RD16/0016/0003, RD16/0016/0004, RD16/0016/0006, RD16/0016/0007, RD16/0016/0008, RD16/0016/0010, and RD16/0016/0011), co-financed by the European Development Regional Fund “A way to achieve Europe,” Operative Program Intelligent Growth 2014–2020, and CIBERINFEC (CB21/13/00095, CB21/13/00012, CB21/13/00049, CB21/13/00054, CB21/13/00055, CB21/13/00068, CB21/13/00081, CB21/13/00084, and CB21/13/00099). 2024-12-17T08:42:25Z 2024-12-17T08:42:25Z 2024-12 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Salamanca-Rivera E, Palacios-Baena ZR, Cañada JE, Moure Z, Pérez-Vázquez M, Calvo-Montes J, et al. Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain. Infection. 2024 Dec;52:2231–40. 1439-0973 https://hdl.handle.net/11351/12340 10.1007/s15010-024-02267-0 38703288 001253695800001 http://hdl.handle.net/11351/12340 eng Infection;52 https://doi.org/10.1007/s15010-024-02267-0 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf Springer Scientia