Cañada García, Javier E.Moure, ZairaSola Campoy, Pedro J.Delgado Valverde, MercedesCano, María E.Gijón Cordero, DesiréeGonzález, MónicaGracia Ahufinger, IreneLarrosa, NievesMulet, XavierPitart, CristinaRivera, AlbaBou, GermánCalvo, JorgeCantón, RafaelGonzález-López, Juan JoséMartínez-Martínez, LuisNavarro, FerranOliver, AntonioPalacios Baena, Zaira R.Pascual, AlvaroRuiz Carrascoso, GuillermoVila Estapé, JordiAracil, BelénPérez-Vázquez, MaríaOteo Iglesias, JesúsGEMARA/GEIRAS-SEIMC/REIPI CARB-ES-19 Study Group2022-11-292022-11-292022-06-301664-302Xhttps://hdl.handle.net/2445/191256CARB-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-3.13 p.application/pdfengcc-by (c) Cañada García, Javier E. et al., 2022https://creativecommons.org/licenses/by/4.0/Antibiòtics betalactàmicsKlebsiella pneumoniaeEscheríchia coliGenoma humàEnterobacteriàciesBeta lactam antibioticsKlebsiella pneumoniaeEscherichia coliHuman genomeEnterobacteriaceaeinfo:eu-repo/semantics/article7256292022-11-29info:eu-repo/semantics/openAccess35847090