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

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.

Prevalence and in vitro antifungal susceptibility of cryptic species of the genus Aspergillus isolated in clinical samples / Prevalencia y sensibilidad antifúngica in vitro de especies crípticas del género Aspergillus aisladas en muestras clínicas

INTRODUCTION: The genus Aspergillus contains more than 300 species, which are divided into closely related groups called sections. Molecular studies have revealed numerous cryptic species within different sections of this genus, which have different profiles of antifungal susceptibility and lack diagnostic morphological features. However, there are few studies on the prevalence and in vitro antifungal susceptibility of the cryptic species of this genus. The aim of this study was to investigate the distribution of Aspergillus spp. among clinical samples, and to study their in vitro susceptibility to different antifungal drugs. METHOD: Over a period of 2-years (2014-2015), a total of 379 strains of the genus Aspergillus were isolated. Most of the isolates were classified as respiratory colonizations; no cases of invasive aspergillosis were found. The strains were identified by MALDI-TOF mass spectrometry, and susceptibility testing was performed by the EUCAST reference procedure. RESULTS: Twenty species belonging to 8 sections were identified, being A. fumigatus the most prevalent (44.1%). The prevalence of cryptic species was 15.3%, with a clear predominance of A. tubingensis. Among the tested antifungal drugs, amphotericin B was the less active in vitro, followed by triazole drugs and echinocandins. The cryptic species had minimun inhibitory concentrations (MICs) higher than the corresponding type species. CONCLUSIONS: Accurate identification of the genus Aspergillus at the species level and in vitro antifungal susceptibility testing are necessary because, as it has been shown, some species of this genus may show resistance profiles against available antifungal drugs

INTRODUCCIÓN: El género Aspergillus contiene más de 300 especies, que se dividen en grupos estrechamente relacionados llamados secciones. Los estudios moleculares han revelado la existencia de numerosas especies crípticas dentro de las diferentes secciones de este género, las cuales tienen diferentes perfiles de sensibilidad antifúngica y carecen de características morfológicas diferenciales de diagnóstico. Sin embargo, hay pocos estudios sobre la prevalencia y la sensibilidad antifúngica in vitro de las especies crípticas de este género. El objetivo de este estudio fue investigar la distribución de Aspergillus spp. en muestras clínicas, y estudiar su sensibilidad in vitro a diferentes fármacos antimicóticos. MÉTODOS: Durante un período de 2 años (2014-2015), se aislaron un total de 379 cepas del género Aspergillus. La mayoría de los aislamientos se clasificaron como colonizaciones respiratorias; no encontrándose casos de aspergilosis invasiva. Las cepas se identificaron mediante espectrometría de masas MALDI-TOF, y las pruebas de sensibilidad antifúngica se realizaron mediante el procedimiento de referencia EUCAST. RESULTADOS: Se identificaron 20 especies pertenecientes a 8 secciones, siendo A. fumigatus la más prevalente (44,1%). La prevalencia de especies crípticas fue del 15,3%, con un claro predominio de A. tubingensis. Entre los fármacos antimicóticos probados, la anfotericina B fue la menos activa in vitro, seguida de los fármacos triazoles y las equinocandinas. Las concentraciones mínimas inhibitorias (CMIs) de los antifúngicos fueron más elevadas frente a las especies crípticas que frente a las especies tipo correspondientes. CONCLUSIONES: La identificación precisa de Aspergillus a nivel de especie y las pruebas de sensibilidad a antifúngicos in vitro son necesarias porque, como se ha demostrado, algunas especies de este género presentan diferentes perfiles de resistencia frente a los fármacos antimicóticos disponibles

Prevalence and in vitro antifungal susceptibility of cryptic species of the genus Aspergillus isolated in clinical samples.

INTRODUCTION: The genus Aspergillus contains more than 300 species, which are divided into closely related groups called sections. Molecular studies have revealed numerous cryptic species within different sections of this genus, which have different profiles of antifungal susceptibility and lack diagnostic morphological features. However, there are few studies on the prevalence and in vitro antifungal susceptibility of the cryptic species of this genus. The aim of this study was to investigate the distribution of Aspergillus spp. among clinical samples, and to study their in vitro susceptibility to different antifungal drugs. METHOD: Over a period of 2-years (2014-2015), a total of 379 strains of the genus Aspergillus were isolated. Most of the isolates were classified as respiratory colonizations; no cases of invasive aspergillosis were found. The strains were identified by MALDI-TOF mass spectrometry, and susceptibility testing was performed by the EUCAST reference procedure. RESULTS: Twenty species belonging to 8 sections were identified, being A. fumigatus the most prevalent (44.1%). The prevalence of cryptic species was 15.3%, with a clear predominance of A. tubingensis. Among the tested antifungal drugs, amphotericin B was the less active in vitro, followed by triazole drugs and echinocandins. The cryptic species had minimun inhibitory concentrations (MICs) higher than the corresponding type species. CONCLUSIONS: Accurate identification of the genus Aspergillus at the species level and in vitro antifungal susceptibility testing are necessary because, as it has been shown, some species of this genus may show resistance profiles against available antifungal drugs.

Enfermedad recurrente por Clostridium difficile ribotipo 027 / Recurrent disease due to ribotype 027 Clostridium difficile

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