title: Community-Onset Bloodstream and Other Infections, Caused by Carbapenemase-ProducingEnterobacteriaceae: Epidemiological, Microbiological, and Clinical Features.
abstract: Background.Because most infections caused by carbapenemase-producingEnterobacteriaceae(CPE) begin during hospitalization, there are limited data about community-onset (CO) infections caused by CPE. Our aim is to describe the frequency of CO infections caused by CPE as well as the clinical features of CO bloodstream infections (CO-BSIs).Methods.This study includes retrospective case series of CO infections caused by CPE in a tertiary hospital from January 2010 to July 2014. Any clinical sample with a positive culture for CPE that had been ordered by primary care doctors or by doctors at the emergency room (ER) were classified as CO. Epidemiological and microbiological features of CO cases were assessed as were clinical features of CO-BSIs.Results.Of 780 clinical samples with CPE, 180 were requested at the ER or by primary care doctors (22.9%), 150 of which were produced byKlebsiella pneumoniae(83.3%). TheblaOXA-48gene was detected in 149 isolates (82.8%) followed by theblaVIMgene, 29 (16.1%). Sixty-one patients (33.9%) had a prior history of CPE infection/colonization. Thirty-four of the 119 (28.6%) patients without prior history of CPE infection/colonization did not fulfill Friedman criteria for healthcare-associated infections (HAIs). Considering previous hospitalization of up to 12 months as a criterion for defining HAI, only 16 (13.4%) cases were identified as community-acquired infections. The most frequent positive sample was urine (133 of 180; 73.9%). Twenty-one (11.7%) patients had a BSI, 9 of them secondary to urinary tract infections (42.9%). Thirty-day crude mortality among patients with BSI was 23.8% (5 of 21).Conclusions.Community-onset infections caused by CPE are an important subgroup of all CPE infections. The urinary tract is the main source. Bloodstream infections accounted for more than 10% of the cases.
authors.affiliation: Infectious Diseasesand Clinical Microbiology Unit, Department of Internal Medicine; Division of Infectious Diseases, Hospital Clínico Universitario "Lozano Blesa",; Instituto de Investigaciones Sanitarias (IIS) de Aragón, Zaragoza, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Paño-Pardo
authors.affiliation: Department of Microbiology.
authors.forename: Beatriz
authors.initials: B
authors.lastname: López Quintana
authors.affiliation: Department of Microbiology.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lázaro Perona
authors.affiliation: Department of Microbiology.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz Carrascoso
authors.affiliation: Department of Microbiology.
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Romero-Gómez
authors.affiliation: Infectious Diseases and Clinical Microbiology Unit, Department of Microbiology.
authors.forename: Belén
authors.initials: B
authors.lastname: Loeches Yagüe
authors.affiliation: Infectious Diseases and Clinical Microbiology Unit, Department of Internal Medicine.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Díaz-Pollán
authors.affiliation: Department of Emergency Medicine , Hospital Universitario La Paz-IdiPAZ , Madrid.
authors.forename: Ana
authors.initials: A
authors.lastname: Martínez-Virto
authors.affiliation: Department of Microbiology.
authors.forename: Jesús
authors.initials: J
authors.lastname: Mingorance
authors.affiliation: Department of Microbiology.
authors.forename: Julio
authors.initials: J
authors.lastname: García Rodríguez
authors.affiliation: Infectious Diseases and Clinical Microbiology Unit, Department of Internal Medicine.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Arribas
authors.affiliation: Department of Microbiology.
authors.forename: Rosa
authors.initials: R
authors.lastname: Gómez-Gil
keywords: bloodstream infections; carbapenemase-producing Enterobacteriaceae; community-onset infections; epidemiology