title: A single-day point-prevalence study of faecal carriers in long-term care hospitals in Madrid (Spain) depicts a complex clonal and polyclonal dissemination of carbapenemase-producing Enterobacteriaceae.
abstract: OBJECTIVE
  The objective of this study was to describe the prevalence and microbiological characteristics of carbapenemase-producing Enterobacteriaceae (CPE) colonizing patients in long-term care hospitals (LTCHs) in Madrid, Spain.
  
  
  METHODS
  Three LTCHs were included in a single-day point-prevalence survey (September 2013). Rectal swabs, collected from all hospitalized patients (137 in LTCH-A, 121 in LTCH-B and 83 in LTCH-C), were plated onto chromogenic media. Population structure (PFGE and MLST), genes encoding carbapenemases and ESBLs and plasmids carrying carbapenemase genes were characterized.
  
  
  RESULTS
  The prevalence of CPE carriers was 4.1% (14/341) [2.9% (4/137), LTCH-A; 4.1% (5/121), LTCH-B; and 6.0% (5/83), LTCH-C]. OXA-48 was the most prevalent carbapenemase (nine Klebsiella pneumoniae, two Escherichia coli, one Enterobacter cloacae and one Citrobacter braakii) followed by VIM-1 (one K. pneumoniae and one Raoultella ornithinolytica). One patient (LTCH-C) was co-colonized with OXA-48-producing K. pneumoniae and E. coli. K. pneumoniae and E. coli isolates also coproduced CTX-M-15 (n = 11) or CTX-M-9 (n = 1) enzymes. K. pneumoniae clustered into six PFGE types corresponding to ST11 (n = 1), ST15 (n = 6), ST307 (n = 1) and ST405 (n = 2). E. coli from LTCH-A and LTCH-C exhibited two different PFGE types associated with ST68. OXA-48 and VIM-1 enzymes were found in different clones in LTCH-A and LTCH-C. However, OXA-48 was the only carbapenemase detected in LTCH-B, mainly associated with K. pneumoniae ST15. KPC, IMP and NDM enzymes were not detected. blaOXA-48 was located on an ∼ 60 kb plasmid with a pOXA-48a-IncL/M backbone.
  
  
  CONCLUSIONS
  We describe the first point-prevalence study of CPE faecal carriers in LTCHs in Spain. OXA-48, the most prevalent carbapenemase, showed a complex dissemination pattern with clonal and polyclonal bacterial populations.
authors.affiliation: Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ruiz-Garbajosa
authors.affiliation: Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Hernández-García
authors.affiliation: Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Beatobe
authors.affiliation: Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Tato
authors.affiliation: Área de Epidemiología, Consejería de Sanidad, Madrid, Spain.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Méndez
authors.affiliation: Hospital Virgen de La Poveda, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Grandal
authors.affiliation: Hospital de La Fuenfría, Madrid, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Aranzábal
authors.affiliation: Hospital de Guadarrama, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Alonso
authors.affiliation: Área de Epidemiología, Consejería de Sanidad, Madrid, Spain.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Lópaz
authors.affiliation: Área de Epidemiología, Consejería de Sanidad, Madrid, Spain.
authors.forename: Jenaro
authors.initials: J
authors.lastname: Astray
authors.affiliation: Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain rafael.canton@salud.madrid.org.
authors.forename: Rafael
authors.initials: R
authors.lastname: Cantón
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D018562:Disease Transmission, Infectious; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D005243:Feces / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D010957:Plasmids / Q000032:analysis; D015995:Prevalence; D013030:Spain / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase