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. 2024 Dec;52(6):2231-2240.
doi: 10.1007/s15010-024-02267-0. Epub 2024 May 4.

Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain

Elena Salamanca-Rivera #  1   2 , Zaira R Palacios-Baena #  3   4 , Javier E Cañada  2   5 , Zaira Moure  5   6 , María Pérez-Vázquez  2   5 , Jorge Calvo-Montes  2   6 , Luis Martínez-Martínez  2   7 , Rafael Cantón  2   8 , Guillermo Ruiz Carrascoso  2   9 , Cristina Pitart  2   10 , Ferran Navarro  11 , Germán Bou  2   12 , Xavier Mulet  2   13 , Juan José González-López  2   14 , Fran Sivianes  1 , Mercedes Delgado-Valverde  1   2 , Álvaro Pascual  1   2 , Jesús Oteo-Iglesias #  2   5 , Jesús Rodríguez-Baño #  15   16 ; GEMARA/GEIRAS-SEIMC/REIPI CARB–ES–19 Group
Collaborators, Affiliations

Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain

Elena Salamanca-Rivera et al. Infection. 2024 Dec.

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.

Keywords: Carbapenem resistant Enterobacterales; Clinical features; KPC-3; OXA-48; Risk factors.

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Conflict of interest statement

Declarations. Conflict of interest: ZRPB has collaborated in educational activities for GILEAD. ESR has collaborated in educational activities for GILEAS, Astra-Zeneca and MSD. LMM has been an advisor and/or has collaborated in educational activities for MSD, Shionogi, Astra-Zeneca, Astellas, Becton Dickinson, and Pfizer. JGL has collaborated in educational activities for MSD and Shionogi. All other authors have no conflicts of interest.

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