Characterization and Clinical Impact of Bloodstream Infection Caused by Carbapenemase-Producing Enterobacteriaceae in Seven Latin American Countries.
Infections caused by carbapenem-resistant Enterobacteriaceae are a public health problem associated with higher mortality rates, longer hospitalization and increased healthcare costs. We carried out a study to describe the characteristics of patients with carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE bloodstream infection (BSI) from Latin American hospitals and to determine the clinical impact in terms of mortality and antibiotic therapy.



Between July 2013 and November 2014, we conducted a multicenter observational study in 11 hospitals from 7 Latin American countries (Argentina, Colombia, Ecuador, Guatemala, Mexico, Peru, Venezuela). Patients with BSI caused by Enterobacteriaceae were included and classified either as CPE or non-CPE based on detection of blaKPC, blaVIM, blaIMP, blaNDM and blaOXA-48 by polymerase chain reaction. Enrolled subjects were followed until discharge or death. Demographic, microbiological and clinical characteristics were collected from medical records. Both descriptive and inferential statistics were used to analyze the information.



A total of 255 patients with Enterobacteriaceae BSI were included; CPE were identified in 53 of them. In vitro non-susceptibility to all screened antibiotics was higher in the patients with CPE BSI, remaining colistin, tigecycline and amikacin as the most active drugs. Combination therapy was significantly more frequent in the CPE BSI group (p < 0.001). The most common regimen was carbapenem + colistin or polymyxin B. The overall mortality was 37% (94/255). Overall and attributable mortality were significantly higher in patients with CPE BSI (p < 0.001); however, we found that patients with CPE BSI who received combination therapy and those who received monotherapy had similar mortality. After multivariate adjustment, CPE BSI (adjusted odds ratio [aOR] 4; 95% confidence interval [CI] 1.7-9.5; p = 0.002) and critical illness (aOR 6.5; 95% CI 3.1-13.7; p < 0.001) were independently associated with in-hospital mortality.



This study provides valuable data on the clinical characteristics and mortality risk factors in patients with CPE BSI. We determined that CPE infection is an independent mortality predictor and thus Latin American hospitals should perform campaigns on prevention and control of CPE BSI.
International Center for Medical Research and Training (CIDEIM), Cali, Colombia.
Maria Virginia
MV
Villegas
International Center for Medical Research and Training (CIDEIM), Cali, Colombia.|Hospital Universitario del Valle Evaristo García E.S.E., Cali, Colombia.
Christian J
CJ
Pallares
International Center for Medical Research and Training (CIDEIM), Cali, Colombia.
Kevin
0000-0002-7173-7486
K
Escandón-Vargas
International Center for Medical Research and Training (CIDEIM), Cali, Colombia.
Cristhian
C
Hernández-Gómez
International Center for Medical Research and Training (CIDEIM), Cali, Colombia.
Adriana
A
Correa
Hospital Universitario San Ignacio, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.
Carlos
C
Álvarez
Clínica Fundación Valle del Lili, Cali, Colombia.
Fernando
F
Rosso
Pontificia Universidad Javeriana, Cali, Colombia.
Lorena
L
Matta
Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.
Carlos
C
Luna
Hospital Vozandes, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
Jeannete
J
Zurita
Hospital Roosevelt, Guatemala City, Guatemala.
Carlos
C
Mejía-Villatoro
Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico.
Eduardo
E
Rodríguez-Noriega
Hospital Nacional Cayetano Heredia, Lima, Peru.
Carlos
C
Seas
Hospital de Clínicas Caracas, Caracas, Venezuela.
Manuel
M
Cortesía
Centro Médico de Caracas, Caracas, Venezuela.
Alfonso
A
Guzmán-Suárez
Centro Médico de Caracas, Caracas, Venezuela.
Manuel
M
Guzmán-Blanco
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000096:biosynthesis*; D002648:Child; D002675:Child, Preschool; D004755:Enterobacteriaceae / Q000187:drug effects; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis*
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase