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. 2023 Sep 8:14:1247804.
doi: 10.3389/fmicb.2023.1247804. eCollection 2023.

The CARBA-MAP study: national mapping of carbapenemases in Spain (2014-2018)

Affiliations

The CARBA-MAP study: national mapping of carbapenemases in Spain (2014-2018)

Irene Gracia-Ahufinger et al. Front Microbiol. .

Abstract

Introduction: Infections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018.

Methods: A national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0.

Results: A total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017-2018 compared to 2014-2016.

Discussion: Data from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms.

Keywords: Enterobacter cloacae complex; Escherichia coli; Klebsiella (Enterobacter) aerogenes; Klebsiella pneumoniae; Pseudomonas aeruginosa; carbapenemases; geographical distribution.

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Conflict of interest statement

LM-M has been a consultant for MSD, Shionogi and Fastinov, has served as speaker for Merck, Astra-Zeneca, Astellas, and Becton Dickinson and has received research support from MSD, Shionogi, Janssen-Cilag and Pfizer. JD-R is an employee of MSD Spain. RC has participated in educational programs organized by MSD, Pfizer and Shionogi and has received research support form MSD, and Venatrox. NL-E has been a consultant for MSD, Menarini, Shionogi and Fastinov and has served as a speaker for MSD, Pfizer, Menarini, Shionogi, Biomerieux and Accelerate Diagnostics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Geographical distribution of carbapenemase-producing microorganisms. Distribution of carbapenemases in Enterobacterales. Distribution of carbapenemases in Pseudomonas aeruginosa. The map shows a pie chart at each participating hospital with the distribution and total number of carbapenemases in Enterobacterales (A) and Pseudomonas aeruginosa (B). *Pie charts corresponding to the Community of Madrid participating hospitals are shown at the side of the map in order to avoid overlaping.
Figure 2
Figure 2
Temporal evolution of carbapenemase types. (A) In Enterobacterales. (B) In Pseudomonas aeruginosa. MBL: metallo-β-lactamases; Combination of different carbapenemases (OXA-48-like+KPC, OXA-48-like+NDM, OXA-48-like+VIM, KPC + VIM).

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