Zaira R Palacios-Baena1, Jesús Oteo2, Carmen Conejo3, M Nieves Larrosa4, Germán Bou5, Marta Fernández-Martínez6, Juan José González-López4, Vicente Pintado7, Luis Martínez-Martínez8, María Merino5, Virginia Pomar9, Marta Mora-Rillo10, María Alba Rivera9, Antonio Oliver11, Guillermo Ruiz-Carrascoso12, Patricia Ruiz-Garbajosa13, Laura Zamorano11, Verónica Bautista2, Adriana Ortega2, Isabel Morales1, Álvaro Pascual3, José Campos14, Jesús Rodríguez-Baño15. 1. Unidad de Gestión Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain. 2. Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain. 3. Unidad de Gestión Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; Departmento de Microbiología, Universidad de Sevilla, Spain. 4. Servei de Microbiologia, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain. 5. Servicio de Microbiología-INIBIC, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain. 6. Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain. 7. Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain. 8. Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain. 9. Servei de Microbiología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain. 10. Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain. 11. Servicio de Microbiología, Hospital Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain. 12. Servicio de Microbiología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain. 13. Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain. 14. Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Consejo Superior de Investigaciones Científicas, Madrid, Spain. 15. Unidad de Gestión Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Spain. Electronic address: jesusrb@us.es.
Abstract
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.
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.
Authors: Elizabeth L Alexander; Jeffery Loutit; Mario Tumbarello; Richard Wunderink; Tim Felton; George Daikos; Karen Fusaro; Dan White; Shu Zhang; Michael N Dudley Journal: Open Forum Infect Dis Date: 2017-06-01 Impact factor: 3.835
Authors: Belén Gutiérrez-Gutiérrez; Jesús Sojo-Dorado; José Bravo-Ferrer; Nienke Cuperus; Marlieke de Kraker; Tomislav Kostyanev; Lul Raka; George Daikos; Jan Feifel; Laura Folgori; Alvaro Pascual; Herman Goossens; Seamus O'Brien; Marc J M Bonten; Jesús Rodríguez-Baño Journal: BMJ Open Date: 2017-04-03 Impact factor: 2.692
Authors: María E Pachón-Ibáñez; Gema Labrador-Herrera; Tania Cebrero-Cangueiro; Caridad Díaz; Younes Smani; José P Del Palacio; Jesús Rodríguez-Baño; Alvaro Pascual; Jerónimo Pachón; M Carmen Conejo Journal: Front Microbiol Date: 2018-05-15 Impact factor: 5.640