Clinical Burden of Carbapenemase-Producing Enterobacterales in Spain: A Multicenter Retrospective Study from Five Hospitals

Introduction: This study assessed the clinical burden of carbapenemase-producing Enterobacterales (CPE) infections according to different resistance mechanisms among Enterobacterales isolates in Spain. Methods: This retrospective study was conducted in five Spanish hospitals from the National Mapping of Carbapenemases in Spain study. Patients were included if they were 18 years or older; had a diagnosis of complicated intraabdominal infection (cIAI), complicated urinary tract infection (cUTI), bloodstream infection (BSI), or hospital-acquired or ventilator-acquired bacterial pneumonia (HABP/VABP) between 2017 and 2018; and had a confirmed CPE isolate. Results: carbapenemase (KPC; n = 82, 69.5%), followed by OXA-48 (n = 27, 22.9%) and metallo-β-lactamases (MBL; n = 9, 7.6%). Overall, 75 patients (63.6%) died from any cause, including 21 deaths (28.0% of all deaths) attributable to the current infection. Clinical cure was achieved in 92 patients (78.0%) and microbiological cure in 59 (54.6%). Among the 92 patients discharged alive, 29 (31.5%) were readmitted for an infectious disease, and relapse within 30 days occurred in 10 patients (10.9%). Discussion: Data suggest that CPE infections are associated with a high disease burden, low rates of clinical cure, and high rates of relapse and mortality in Spain. However, results should be interpreted with caution due to the limited sample size which may have restricted the precision of these estimates and gaps in minimal inhibitory concentration data availability.