Epidemiological and clinical characterization of community, healthcare-associated and nosocomial colonization and infection due to carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Spain
Authors: Salamanca-Rivera Elena , Palacios-Baena Zaira R. , Cañada Javier E. , Moure Zaira , Pérez-Vázquez María , Calvo-Montes Jorge , Martínez-Martínez Luis , Cantón Rafael , Ruiz Carrascoso Guillermo , Pitart Cristina , Navarro Ferran , Bou Germán , Mulet Xavier , González-López Juan José , Sivianes Fran , Delgado-Valverde Mercedes , Pascual Álvaro , Oteo-Iglesias Jesús , Rodríguez-Baño Jesús ,   The GEMARA/GEIRAS-SEIMC/REIPI CARB–ES–19 Group, Martínez Ramírez Mariela , Ortega Lafont M. Pilar , Cercenado Emilia , del Rosario Cristobal , Perez Arellano Jose Luis , Lecuona María , López-Urrutia Lorente Luis , Leiva José , del Pozo José Luis , Giner Salvador , Frasquet Juan , Garcia Agudo Lidia , Illescas Soledad , de la Iglesia Pedro , Sánchez Benito Rosario , Garduño Eugenio , Fernández Natal Ma Isabel , Arias Marta , Pérez Moreno Mar Olga , López-Calleja Ana Isabel , Azcona José Manuel , Belles Alba , García González Mercè , Valverde Troya Miriam , Palop Begoña , García Garrote Fernando , Barrios Andrés Jose Luis , López Soria Leyre , Gimeno Adelina , Clapés Sanchez Ester , Villa Jennifer , Iglesias Nuñez Nuria , Sánchez Arroyo Rafael , Hernando Susana , Riquelme Bravo Eva , Sainz de Baranda Caridad , Esparcia Rodríguez Oscar , Gaitán Jorge , Huertas María , Rodríguez Escudero M. José , Aldea Carmen , Sanchez Nerea , Casabella Pernas Antonio , Quesada Ma Dolores , Martí Sala Carmina , Mora Laura , Clavijo Encarnación , Chueca Natalia , GarcíaSánchez Federico Juan Manuel , Galán Sánchez Fátima , Liébana Carmen , Roldán Carolina , Cabeza Ma Isabel , Cabezas Fernández Ma Teresa , Martínez Lamas Lucía , Rey Cao Sonia , Paz Vidal Ma Isabel , Andrés Raquel Elisa Rodríguez Tarazona y N , Coira Nieto Amparo , Pérez del Molino Bernal Ma Luisa , Gomáriz Díaz María , Vidal-García Matxalen , de Tuesta Díaz Jose Luis , García Bravo Moises , Tinajas Almudena , Quintano Fe Tubau , García Borja Suberviola Cañas y Maria Elie , Gracia-Ahufinger Irene , González Bardanca Mónica , Viñado Belén , Nuvials Xavier , Roca Ignasi , Ruiz-Garbajosa Patricia , Gijon Desireé , Pintado Vicente , Rivera Alba , Campos David Gutiérrez , Alemán Aurora , Ayestarán Ignacio , García Andrés Canut Blasco y Jorge Arribas 
Published: May 2024

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.