Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2016 Apr 22;11(4):e0154092.
doi: 10.1371/journal.pone.0154092. eCollection 2016.

Characterization and Clinical Impact of Bloodstream Infection Caused by Carbapenemase-Producing Enterobacteriaceae in Seven Latin American Countries

Maria Virginia Villegas  1 , Christian J Pallares  1   2 , Kevin Escandón-Vargas  1 , Cristhian Hernández-Gómez  1 , Adriana Correa  1 , Carlos Álvarez  3 , Fernando Rosso  4 , Lorena Matta  5 , Carlos Luna  6 , Jeannete Zurita  7 , Carlos Mejía-Villatoro  8 , Eduardo Rodríguez-Noriega  9 , Carlos Seas  10 , Manuel Cortesía  11 , Alfonso Guzmán-Suárez  12 , Manuel Guzmán-Blanco  12
Affiliations
Observational Study

Characterization and Clinical Impact of Bloodstream Infection Caused by Carbapenemase-Producing Enterobacteriaceae in Seven Latin American Countries

Maria Virginia Villegas et al. PLoS One. .

Abstract

Introduction: Infections caused by carbapenem-resistant Enterobacteriaceae are a public health problem associated with higher mortality rates, longer hospitalization and increased healthcare costs. We carried out a study to describe the characteristics of patients with carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE bloodstream infection (BSI) from Latin American hospitals and to determine the clinical impact in terms of mortality and antibiotic therapy.

Methods: Between July 2013 and November 2014, we conducted a multicenter observational study in 11 hospitals from 7 Latin American countries (Argentina, Colombia, Ecuador, Guatemala, Mexico, Peru, Venezuela). Patients with BSI caused by Enterobacteriaceae were included and classified either as CPE or non-CPE based on detection of blaKPC, blaVIM, blaIMP, blaNDM and blaOXA-48 by polymerase chain reaction. Enrolled subjects were followed until discharge or death. Demographic, microbiological and clinical characteristics were collected from medical records. Both descriptive and inferential statistics were used to analyze the information.

Results: A total of 255 patients with Enterobacteriaceae BSI were included; CPE were identified in 53 of them. In vitro non-susceptibility to all screened antibiotics was higher in the patients with CPE BSI, remaining colistin, tigecycline and amikacin as the most active drugs. Combination therapy was significantly more frequent in the CPE BSI group (p < 0.001). The most common regimen was carbapenem + colistin or polymyxin B. The overall mortality was 37% (94/255). Overall and attributable mortality were significantly higher in patients with CPE BSI (p < 0.001); however, we found that patients with CPE BSI who received combination therapy and those who received monotherapy had similar mortality. After multivariate adjustment, CPE BSI (adjusted odds ratio [aOR] 4; 95% confidence interval [CI] 1.7-9.5; p = 0.002) and critical illness (aOR 6.5; 95% CI 3.1-13.7; p < 0.001) were independently associated with in-hospital mortality.

Conclusions: This study provides valuable data on the clinical characteristics and mortality risk factors in patients with CPE BSI. We determined that CPE infection is an independent mortality predictor and thus Latin American hospitals should perform campaigns on prevention and control of CPE BSI.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: MVV has received consulting honorarium and/or research grant support from Merck, Janssen-Cilag, Pfizer, MSD, AstraZeneca, Zambon and Abbott. CJP has been consultant for Merck, MSD, Pfizer, Novartis, AstraZeneca and Amarey. CHG has been consultant for MSD and Merck. CA has received consulting honorarium and/or research grant support from MSD, Pfizer, GlaxoSmithKline, AstraZeneca and Janssen-Cilag. MGB has participated in advisory boards of Pfizer, MSD and BD. All other authors reported no competing interests relevant to this article. This statement does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Kaplan-Meier survival estimates at 7 days of patients with carbapenemase-producing Enterobacteriaceae (CPE) bloodstream infection (BSI) (dashed line) vs. non-CPE BSI (solid line).
p < 0.001 (log rank test).
See this image and copyright information in PMC

References

    1. Tzouvelekis LS, Markogiannakis A, Psichogiou M, Tassios PT, Daikos GL. Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clin Microbiol Rev. 2012;25: 682–707. 10.1128/CMR.05035-11 - DOI - PMC - PubMed
    1. Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008;29: 1099–1106. 10.1086/592412 - DOI - PubMed
    1. Guh AY, Bulens SN, Mu Y, Jacob JT, Reno J, Scott J, et al. Epidemiology of Carbapenem-Resistant Enterobacteriaceae in 7 US Communities, 2012–2013. JAMA. 2015;314: 1479–87. 10.1001/jama.2015.12480 - DOI - PMC - PubMed
    1. Nordmann P. Carbapenemase-producing Enterobacteriaceae: overview of a major public health challenge. Med Mal Infect. Elsevier Masson SAS; 2014;44: 51–56. 10.1016/j.medmal.2013.11.007 - DOI - PubMed
    1. Maya JJ, Ruiz SJ, Blanco VM, Gotuzzo E, Guzman-Blanco M, Labarca J, et al. Current status of carbapenemases in Latin America. Expert Rev Anti Infect Ther. 2013;11: 657–67. 10.1586/14787210.2013.811924 - DOI - PubMed

Publication types

MeSH terms