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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/221587
Whole Genome Sequencing Analysis of Klebsiella pneumoniae Isolates from Health Care–Associated Bacteremia of Urinary Origin in Spain: Findings from the Multicenter ITUBRAS-2 Cohort Study
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Background The objective of this study was to assess the microbiological and clinical features of Klebsiella pneumoniae health care-associated bacteremia of urinary origin (HCA-BUO) in Spain, with a focus on third-generation cephalosporin-(3GCR-Kp) and carbapenem-resistant K pneumoniae (CR-Kp) isolates.Methods A total of 96 (21.4%, 96/449) K pneumoniae blood isolates were prospectively collected from patients with HCA-BUO (n = 443) from 12 tertiary care hospitals in Spain (2017-2019). Antimicrobial susceptibility was determined (standard broth microdilution), and extended-spectrum beta-lactamase, AmpC, and carbapenemase production was screened. A subset of 55 K pneumoniae isolates was analyzed by whole genome sequencing (Illumina) to determine population structure, resistome, and virulome. Additionally, 13 of these isolates were subjected to long-read sequencing (Nanopore) for plasmid characterization. Patients' baseline and clinical characteristics were reviewed.Results 3GCR-Kp prevalence was 43.8% (42/96), mostly associated with extended-spectrum beta-lactamase production (34/96, 35.4%; mainly CTX-M-15, 32/34, 94.1%) and the dissemination of sequence type (ST)-307 (15/34, 44.1%) and other globally spread multidrug-resistant high-risk clones. CR-Kp prevalence was 9.4% (9/96); all isolates belonged to different STs and were mostly associated with carbapenemase production (6/9, 66.7%; mainly OXA-48-like, n = 3). Additionally, 3GCR-Kp and CR-Kp isolates showed higher content of other antibiotic resistance genes. Altogether, these episodes were associated with prior antibiotic use and receipt of inadequate empirical treatment.Conclusions There is a high prevalence of 3GCR and CR-Kp causing HCA-BUO in Spain, mainly driven by the dissemination of ST307/CTX-M-15 and other globally spread multidrug-resistant high-risk clones, challenging the selection of empirical and targeted treatments for these infections. There is a high prevalence of third-generation cephalosporin- and carbapenem-resistant Klebsiella pneumoniae causing health care-associated bacteremia of urinary origin in Spain. There is also a predominance of ST307/CTX-M-15 and other multidrug-resistant high-risk clones. Third-generation cephalosporin- and carbapenem-resistant K pneumoniae infections were associated with prior antibiotic use and inadequate empirical treatment.
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BECERRA APARICIO, Federico, GÓMEZ ZORRILLA, Silvia, HERNÁNDEZ GARCÍA, Marta, XANTHOPOULOU, Kyriaki, GIJÓN CORDERO, Desirée, SIVERIO, Ana, BERBEL, Dàmaris, CERCENADO, Emilia, RIVERA, Alba, MALET, Ana de, XERCAVINS, Mariona, RUIZ DE GOPEGUI, Enrique, CANOURA FERNÁNDEZ, Luís, MARTÍNEZ MARTÍNEZ, José antonio, SERAL, Cristina, POZO, José luis del, COTARELO, Manuel, PONZ, Ricardo, HIGGINS, Paul g., DURAN JORDÀ, Xavier, CANTÓN, Rafael, OLIVER, Antonio, HORCAJADA GALLEGO, Juan pablo, RUIZ GARBAJOSA, Patricia, ITUBRAS-2 Group. Whole Genome Sequencing Analysis of Klebsiella pneumoniae Isolates from Health Care–Associated Bacteremia of Urinary Origin in Spain: Findings from the Multicenter ITUBRAS-2 Cohort Study. _Open Forum Infectious Diseases_. 2025. Vol. 12, núm. 4. [consulta: 11 de gener de 2026]. ISSN: 2328-8957. [Disponible a: https://hdl.handle.net/2445/221587]