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
Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), CSIC, Universidad de Sevilla, Avda Dr. Fedriani, 3, 41009, Seville, Spain.
CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
Infection. 2024 Dec;52(6):2231-2240. doi: 10.1007/s15010-024-02267-0. Epub 2024 May 4.
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).
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.
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).
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.
由产碳青霉烯酶肠杆菌（CPE）引起的社区获得性（CA）和医疗保健相关（HCA）感染的特征尚不明确。目的是提供有关由产碳青霉烯酶肺炎克雷伯菌（CP-Kp）和大肠埃希菌（CP-Ec）引起的医院感染、HCA感染和CA感染的临床及分子流行病学特征的详细信息。
2019年2月至3月在西班牙的59家医院进行了一项前瞻性队列研究，纳入了连续分离出CP-Kp或CP-Ec的前10例患者。患者根据感染获得类型进行分层。进行多变量分析以确定感染获得类型对30天死亡率的影响。
共纳入386例患者（363例[94%]为CP-Kp，23例[6%]为CP-Ec）；296例患者（76.3%）的CPE导致了感染。31例（8.0%）患者为CA感染，183例（47.4%）为HCA感染，172例（48.3%）为医院感染。在HCA感染患者中，100例（54.6%）此前曾住院，71例（38.8%）为养老院居民。尿路感染分别占CA感染、HCA感染和医院感染的19/23（82.6%）、89/130（68.5%）和42/143（29.4%）。总体而言，68例感染（23%）为菌血症（分别占CA感染、HCA感染和医院感染的8.7%、17.7%和30.1%）。感染患者的死亡率为28%（CA感染、HCA感染和医院感染分别为13%、14.6%和42.7%）。医院血流感染与死亡几率增加相关（校正比值比，4.00；95%置信区间1.21-13.19）。
CPE引起的HCA感染和CA感染很常见且具有临床意义。这些信息可能有助于更好地了解CPE的流行病学。
