Image_1_The CARBA-MAP study: national mapping of carbapenemases in Spain (2014–2018).JPEG (185.33 kB)

Image_1_The CARBA-MAP study: national mapping of carbapenemases in Spain (2014–2018).JPEG

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posted on 2023-09-08, 12:56 authored by Irene Gracia-Ahufinger, Laura López-González, Francisco José Vasallo, Alicia Galar, María Siller, Cristina Pitart, Iván Bloise, Miriam Torrecillas, Desirée Gijón-Cordero, Belén Viñado, Javier Castillo-García, Rainer Campo, Xavier Mulet, Ana Madueño-Alonso, Francisco Javier Chamizo-López, Maitane Arrastia-Erviti, Fátima Galán-Sánchez, Melisa Fernández-Quejo, Juan Carlos Rodríguez-Díaz, María Nieves Gutiérrez-Zufiaurre, Manuel Angel Rodríguez-Maresca, María del Pilar Ortega-Lafont, Genoveva Yagüe-Guirao, Lucía Chaves-Blanco, Javier Colomina-Rodríguez, María Reyes Vidal-Acuña, María Eugenia Portillo, Francisco Franco-Álvarez de Luna, María José Centelles-Serrano, José Manuel Azcona-Gutiérrez, Alberto Delgado-Iribarren García Campero, Sonia Rey-Cao, Patricia Muñoz, Jorge Calvo-Montes, Yuliya Zboromyrska, David Grandioso, Jordi Càmara, Rafael Cantón, Nieves Larrosa-Escartín, Jazmín Díaz-Regañón, Luis Martínez-Martínez

Introduction

Infections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018.

Methods

A national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0.

Results

A total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017–2018 compared to 2014–2016.

Discussion

Data from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms.