@misc{10481/90210,
year = {2022},
month = {6},
url = {https://hdl.handle.net/10481/90210},
abstract = {Objectives: CARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.

Methods: In total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.

Results: In total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were bla OXA-48 (263/377), bla KPC-3 (62/377), bla VIM-1 (28/377), and bla NDM-1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).

Conclusion: This study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3.},
organization = {Instituto de Salud Carlos III (numbers PI18CIII/00030 and PI21CIII/00039)},
organization = {Ministerio de Economía y Competitividad (RD16CIII/0004/0002, RD16/0016/0001, RD16/0016/0003, RD16/0016/0004, RD16/0016/0006, RD16/0016/0007, RD16/0016/0008, RD16/0016/0010, RD16/0016/0011)},
organization = {European Development Regional Fund, Operative Program Intelligent Growth 2014– 2020},
organization = {Consorcio Centro de Investigación Biomédica en Red (CB21/13/00095, CB21/13/00012, CB21/13/00049, CB21/13/00054, CB21/13/00055, CB21/13/00068, CB21/13/00081, CB21/13/00084, CB21/13/00099)},
organization = {Ministerio de Ciencia e Innovación and Unión Europea – NextGenerationEU},
publisher = {Frontiers Media},
keywords = {CARB-ES-19 study},
keywords = {Carbapenemases},
keywords = {Whole genome sequencing},
keywords = {Klebsiella pneumoniae},
keywords = {High-risk clones},
title = {CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumonia e and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3},
doi = {10.3389/fmicb.2022.918362},
author = {Cañada-García, Javier E and Moure, Zaira and Sola-Campoy, Pedro J and Delgado-Valverde, Mercedes and Cano, María E and Gijón, Desirèe and González, Mónica and Gracia-Ahufinger, Irene and Larrosa, Nieves and Mulet, Xavier and Pitart, Cristina and Rivera, Alba and Bou, Germán and Calvo, Jorge and Cantón, Rafael and González-López, Juan José and Martínez-Martínez, Luis and Navarro, Ferran and Oliver, Antonio and Palacios-Baena, Zaira R and Pascual, Álvaro and Ruiz-Carrascoso, Guillermo and Vila, Jordi and Aracil, Belén and Pérez-Vázquez, María and Oteo-Iglesias, Jesús and GEMARA/GEIRAS-SEIMC/REIPI CARB-ES-19 Study Group},
}