Comprehensive Clinical and Epidemiological Assessment of Colonization and Infection due to Carbapenemase-Producing Enterobacteriaceae in Spain

A study performed within the COMBACTE-CARE consortium has recently been published in the Journal of Infection1. The study reports the clinical epidemiology, clinical features, and outcomes of colonisation and infections due to carbapenemase-producing Enterobacteriaceae (CPE) in Spain.

Most available information on CPE is usually associated with specific types of infection or patient or with descriptions of outbreaks. However, Zaira R. Palacios-Baena and co-workers carried out a nationwide multicentre prospective cohort study in Spain to investigate aspects associated with CPE infection, including the importance of non-nosocomial acquisition, whether carbapenemase types are associated with different epidemiological features, and the outcome of different types of infection caused by CPE. The study was performed in 34 Spanish hospitals in  2013.

During three months, 245 new patients testing positive for CPE in clinical samples were included. The study revealed 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.

The most frequent organism encountered was Klebsiella pneumoniae (74%), and the carbapenemases belonged to the OXA-48 (74%), metallo-b-lactamase  (24%), and KPC (2%) groups. Acquisition was nosocomial in 60% and healthcare-associated  in 37% of the cases. 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.