title: Comprehensive clinical and epidemiological assessment of colonisation and infection due to carbapenemase-producing Enterobacteriaceae in Spain.
abstract: BACKGROUND
  Most available information on carbapenemase-producing Enterobacteriaceae (CPE) is usually associated with specific types of infection or patient or with descriptions of outbreaks. The aim of this study was to comprehensively analyse the clinical epidemiology, clinical features and outcomes of colonisation and infections due to CPE in Spain.
  
  
  METHODS
  A multicentre prospective cohort study was carried out in 34 Spanish hospitals from February to May 2013. All new patients testing positive for CPE in clinical samples were included. Logistic regression was used to identify predictors of mortality.
  
  
  RESULTS
  Overall, 245 cases were included. The most frequent organism was Klebsiella pneumoniae (74%) and the carbapenemases belonged to the OXA-48 (74%), metallo-β-lactamase (MBL) (24%) and KPC (2%) groups. Acquisition was nosocomial in 145 cases (60%) and healthcare-associated (HCA) in 91 (37%); 42% of the latter were nursing home residents, in whom OXA-48-producing K. pneumoniae ST405 predominated. MBLs and OXA-48 predominated in ICU and medical patients, respectively. Overall, 67% of patients had infections. The most frequent infections identified in this study were urinary tract (43%) and skin structure (21%) infections, and 10% of infections were bacteraemic. Crude mortality was 20%. Inappropriate antibiotic therapy was independently associated with an increased risk of death (OR = 3.30; 95% CI: 1.34-8.11).
  
  
  CONCLUSIONS
  We found some differences in the epidemiology of CPE depending on the type of carbapenemase produced. Although a low proportion of CPE infections were bacteraemic, active antibiotic therapy was a protective factor for reducing mortality.
authors.affiliation: Unidad de Gestión Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain.
authors.forename: Zaira R
authors.initials: ZR
authors.lastname: Palacios-Baena
authors.affiliation: Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Oteo
authors.affiliation: Unidad de Gestión Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; Departmento de Microbiología, Universidad de Sevilla, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Conejo
authors.affiliation: Servei de Microbiologia, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M Nieves
authors.initials: MN
authors.lastname: Larrosa
authors.affiliation: Servicio de Microbiología-INIBIC, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: Germán
authors.initials: G
authors.lastname: Bou
authors.affiliation: Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Fernández-Martínez
authors.affiliation: Servei de Microbiologia, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: González-López
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Pintado
authors.affiliation: Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Martínez
authors.affiliation: Servicio de Microbiología-INIBIC, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Merino
authors.affiliation: Servei de Microbiología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Pomar
authors.affiliation: Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Mora-Rillo
authors.affiliation: Servei de Microbiología, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
authors.forename: María Alba
authors.initials: MA
authors.lastname: Rivera
authors.affiliation: Servicio de Microbiología, Hospital Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliver
authors.affiliation: Servicio de Microbiología, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Carrascoso
authors.affiliation: Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ruiz-Garbajosa
authors.affiliation: Servicio de Microbiología, Hospital Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Zamorano
authors.affiliation: Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: Bautista
authors.affiliation: Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: Adriana
authors.initials: A
authors.lastname: Ortega
authors.affiliation: Unidad de Gestión Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Morales
authors.affiliation: Unidad de Gestión Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; Departmento de Microbiología, Universidad de Sevilla, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Pascual
authors.affiliation: Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Consejo Superior de Investigaciones Científicas, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Campos
authors.affiliation: Unidad de Gestión Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Spain. Electronic address: jesusrb@us.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000378:metabolism*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenem resistant Enterobacteriaceae; Clinical features; Geographic distribution; Risk factors