Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain
Copyright policy )Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain
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.
Male, Pneumònia adquirida a la comunitat, DISEASES::Bacterial Infections and Mycoses::Infection::Community-Acquired Infections, Klebsiella pneumoniae* / enzymology, Community-Acquired Infections* / microbiology, Prospective Studies, Masculino, OXA-48, CHEMICALS AND DRUGS::Enzymes and Coenzymes::Enzymes::Hydrolases::Amidohydrolases::beta-Lactamases, Escherichia coli Infections, Aged, 80 and over, Persona de Mediana Edad, Cross Infection, Escherichia coli Infections* / microbiology, ENFERMEDADES::infecciones bacterianas y micosis::infección::infecciones adquiridas en la comunidad, Adulto, Klebsiella Infections* / microbiology, Femenino, Estudios Prospectivos, Klebsiella Infections* / mortality, Middle Aged, ENFERMEDADES::infecciones bacterianas y micosis::infecciones bacterianas::infecciones por bacterias gramnegativas::infecciones por Enterobacteriaceae::infecciones por Klebsiella, Humanos, Community-Acquired Infections, Cross Infection* / microbiology, Klebsiella pneumoniae, Escherichia coli* / genetics, ENFERMEDADES::infecciones bacterianas y micosis::infecciones bacterianas::infecciones por bacterias gramnegativas::infecciones por Enterobacteriaceae::infecciones por Escherichia coli, Female, COMPUESTOS QUÍMICOS Y DROGAS::enzimas y coenzimas::enzimas::hidrolasas::amidohidrolasas::beta-lactamasas, Adult, Bacterial Proteins / genetics, Anciano, beta-Lactamases, KPC-3, Beta-lactamases, Bacterial Proteins, Bacterial Proteins / metabolism, Escherichia coli, Cross Infection* / epidemiology, Humans, Escherichia coli Infections* / epidemiology, DISEASES::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Enterobacteriaceae Infections::Klebsiella Infections, Aged, beta-Lactamases* / genetics, Spain / epidemiology, Research, Carbapenem resistant enterobacterales, Clinical features, Infeccions nosocomials, DISEASES::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Enterobacteriaceae Infections::Escherichia coli Infections, Enterobacteriàcies, Klebsiella Infections, Klebsiella Infections* / epidemiology, beta-Lactamases* / metabolism, Risk factors, Community-Acquired Infections* / epidemiology, Spain, Klebsiella pneumoniae* / genetics, Carbapenem resistant Enterobacterales, Infeccions per escheríchia coli - Epidemiologia
Male, Pneumònia adquirida a la comunitat, DISEASES::Bacterial Infections and Mycoses::Infection::Community-Acquired Infections, Klebsiella pneumoniae* / enzymology, Community-Acquired Infections* / microbiology, Prospective Studies, Masculino, OXA-48, CHEMICALS AND DRUGS::Enzymes and Coenzymes::Enzymes::Hydrolases::Amidohydrolases::beta-Lactamases, Escherichia coli Infections, Aged, 80 and over, Persona de Mediana Edad, Cross Infection, Escherichia coli Infections* / microbiology, ENFERMEDADES::infecciones bacterianas y micosis::infección::infecciones adquiridas en la comunidad, Adulto, Klebsiella Infections* / microbiology, Femenino, Estudios Prospectivos, Klebsiella Infections* / mortality, Middle Aged, ENFERMEDADES::infecciones bacterianas y micosis::infecciones bacterianas::infecciones por bacterias gramnegativas::infecciones por Enterobacteriaceae::infecciones por Klebsiella, Humanos, Community-Acquired Infections, Cross Infection* / microbiology, Klebsiella pneumoniae, Escherichia coli* / genetics, ENFERMEDADES::infecciones bacterianas y micosis::infecciones bacterianas::infecciones por bacterias gramnegativas::infecciones por Enterobacteriaceae::infecciones por Escherichia coli, Female, COMPUESTOS QUÍMICOS Y DROGAS::enzimas y coenzimas::enzimas::hidrolasas::amidohidrolasas::beta-lactamasas, Adult, Bacterial Proteins / genetics, Anciano, beta-Lactamases, KPC-3, Beta-lactamases, Bacterial Proteins, Bacterial Proteins / metabolism, Escherichia coli, Cross Infection* / epidemiology, Humans, Escherichia coli Infections* / epidemiology, DISEASES::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Enterobacteriaceae Infections::Klebsiella Infections, Aged, beta-Lactamases* / genetics, Spain / epidemiology, Research, Carbapenem resistant enterobacterales, Clinical features, Infeccions nosocomials, DISEASES::Bacterial Infections and Mycoses::Bacterial Infections::Gram-Negative Bacterial Infections::Enterobacteriaceae Infections::Escherichia coli Infections, Enterobacteriàcies, Klebsiella Infections, Klebsiella Infections* / epidemiology, beta-Lactamases* / metabolism, Risk factors, Community-Acquired Infections* / epidemiology, Spain, Klebsiella pneumoniae* / genetics, Carbapenem resistant Enterobacterales, Infeccions per escheríchia coli - Epidemiologia
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