Cañada-García, Javier E.Moure, ZairaSola-Campoy, Pedro JuanDelgado-Valverde, MercedesCano, María E.Gijón, DesireeGonzález, MónicaGracia-Ahufinger, IreneLarrosa, NievesMulet, XavierPitart, CristinaRivera, AlbaBou, GermánCalvo-Montes, JorgeCantón, RafaelGonzález-López, Juan JoséMartínez-Martínez, LuisNavarro, FerránOliver, AntonioPalacios-Baena, Zaira R.Pascual, ÁlvaroRuiz Carrascoso, GuillermoVila, JordiAracil, BelénPérez-Vázquez, MaríaOteo, Jesús2025-02-122025-02-122022-06-30Cañada-García JE, Moure Z, Sola-Campoy PJ, Delgado-Valverde M, Cano ME, Gijón D, González M, Gracia-Ahufinger I, Larrosa N, Mulet X, Pitart C, Rivera A, Bou G, Calvo J, Cantón R, González-López JJ, Martínez-Martínez L, Navarro F, Oliver A, Palacios-Baena ZR, Pascual Á, Ruiz-Carrascoso G, Vila J, Aracil B, Pérez-Vázquez M, Oteo-Iglesias J; GEMARA/GEIRAS-SEIMC/REIPI CARB-ES-19 Study Group. 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. Front Microbiol. 2022 Jun 30;13:918362.1664-302Xhttp://hdl.handle.net/2183/41161[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.engCreative Commons Attribution 4.0 International License (CC-BY 4.0)http://creativecommons.org/licenses/by/3.0/es/CARB-ES-19 studyKlebsiella pneumoniaeCarbapenemasesHigh-risk clonesWhole genome sequencingjournal articleopen access10.3389/fmicb.2022.918362