Characterization of Ceftazidime-Avibactam-Resistant Carbapenem-Resistant Enterobacteriaceae, United States, 2015–2017

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are a major public health problem. Ceftazidime-avibactam (CZA) is a treatment option for CRE approved in 2015; however, it does not have activity against isolates with metallo-β-lactamases (MBLs). Emerging resistance to CZA is a cause for concern. Our objective was to describe the microbiologic and epidemiologic characteristics of CZA-resistant (CZA-R) CRE. Methods: From 2015 to 2017, 9 states participated in laboratory- and population-based surveillance for carbapenem-resistant Escherichia coli, Klebsiella pneumoniae, K. oxytoca, K. aerogenes, and Enterobacter cloacae complex isolates from a normally sterile site or urine. A convenience sample of isolates from this surveillance were sent to the CDC for antimicrobial susceptibility testing (AST) using reference broth microdilution (BMD) including an MBL screen, species confirmation with MALDI-TOF, and real-time PCR to detect blaKPC, blaNDM, and blaOXA-48–like genes. Additional AST by BMD was performed on CZA-R isolates using meropenem-vaborbactam (MEV), imipenem-relebactam (IMR), plazomicin (PLZ), and eravacycline (ERV). Epidemiologic data were obtained from a medical record review. Community-associated cases were defined as having no healthcare exposures in the year prior to culture, no devices in place 2 days prior to culture, and culture collected before calendar day 3 after hospital admission. Data were analyzed in 3 groups: CRE that were CZA-susceptible (CZA-S), CZA-R that were due to blaNDM, and CZA-R without blaNDM. Results: Among 606 confirmed CRE tested with CZA, 33 (5.4%) were CZA-R. Of the CZA-R isolates, 16 (48.5%) harbored a blaNDM gene, of which 2 coharbored blaNDM and blaOXA-48-like genes; 9 (27.3%) harbored only a blaKPC gene. Of the 17 CZA-R isolates without blaNDM, all were MBL screen negative. CZA-R due to blaNDM were more frequently community-associated (43.8%) than CZA-S or CZA-R without blaNDM (11.0% and 5.9%, respectively); a higher percentage of CZA-R cases due to blaNDM also had recent international travel (25%) compared to the other groups (1.8% and 5.9%, respectively). CZA-R without blaNDM were more susceptible to MEV (76%), IMR (71%), PLZ (88%), and ERV (65%) compared to CZA-R due to blaNDM (19%, 6%, 56%, and 44%, respectively). Conclusions: The emergence of CZA-R isolates without blaNDM are concerning; however, these isolates are more susceptible to newer antimicrobials than those with blaNDM. In addition to high rates of resistance to newer antimicrobials, isolates with blaNDM are more frequently community-associated than other CRE. This underscores the need for more aggressive measures to stop the spread of CRE.Funding: NoneDisclosures: None

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507. Epidemiology of Community-Associated Carbapenemase + Producing Carbapenem-Resistant Enterobacteriacae Identified from the Emerging Infections Program, 2012–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.576 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S246-S246

Author(s):

Isaac See ◽

Uzma Ansari ◽

Hannah Reses ◽

Julian E Grass ◽

Erin Epson ◽

...

Keyword(s):

Urinary Tract ◽

Treatment Options ◽

Population Based ◽

International Travel ◽

Community Dwelling ◽

Emerging Infections ◽

Convenience Sample ◽

Carbapenem Resistant ◽

Clinical Diagnoses ◽

Tract Infections

Abstract Background Carbapenemase-producing (CP-) carbapenem-resistant Enterobacteriaceae (CRE) have been almost exclusively linked to extensive healthcare exposure and are of significant concern due to limited treatment options and potential for plasmid-mediated spread of resistance. We report on CP-CRE in community-dwelling individuals. Methods We used 2012–2017 active, laboratory and population-based surveillance data for CRE from CDC’s Emerging Infections Program sites (9 sites by 2017). Cases were the first isolation of Escherichia coli, Klebsiella spp., or Enterobacter spp. from a normally sterile body specimen or urine in a surveillance site resident meeting a CRE phenotype (figure) in a 30 day period. Epidemiologic data were obtained from chart review. Cases were community-associated (CA) if not isolated after the first three days of a hospital stay; without inpatient healthcare, dialysis, or surgery in the year prior; and without indwelling medical devices within two days prior to culture. A convenience sample of isolates was tested at CDC by real-time PCR to detect blaKPC, blaNDM, blaOXA-48-like, blaVIM, or blaIMP. Results Of 4023 CRE cases, 699 (17%) were CA, from which 297 isolates were tested; 20 (7%) were CP-CRE, from 18 patients (2 had repeat isolation of the same gene/species). The median age was 68 years (range: 33–91), and 14 (78%) were female. Patients were from 7 sites (range: 1–4/site). Their CP-CRE (10 blaKPC, 6 blaNDM, and 2 blaOXA-48-like) were from three species (10 K. pneumoniae, 6 E. coli, 2 E. cloacae) and isolated from urine (n = 16) and blood (n = 2). Among those with CP-CRE from urine, 12 (75%) had clinical diagnoses of urinary tract infections and the rest had no infection documented. Overall, 7 (39%) were admitted to a hospital within 30 days of culture; none died during hospitalization. Most (n = 13; 72%) had underlying medical comorbidities, most commonly urinary tract abnormalities (n = 5; 28%) and diabetes mellitus (n = 5; 28%). Three (17%) had international travel within two months prior to culture. Conclusion CA CP-CRE were found in most surveillance sites but are rare, occurring primarily in older patients with underlying medical conditions. Patient interviews are planned to determine whether CA CP-CRE may be associated with distant or undocumented healthcare exposures. Disclosures All authors: No reported disclosures.

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Fragility Fractures and Imminent Fracture Risk in the Spanish Population: A Retrospective Observational Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10051082 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1082

Author(s):

Maria-José Montoya-García ◽

Mercè Giner ◽

Rodrigo Marcos ◽

David García-Romero ◽

Francisco-Jesús Olmo-Montes ◽

...

Keyword(s):

Cohort Study ◽

Incidence Rate ◽

Public Health Problem ◽

Osteoporotic Fractures ◽

Fragility Fractures ◽

Population Based ◽

High Morbidity ◽

Major Public Health Problem ◽

Skeletal Site ◽

Mortality Incidence

Fragility fractures constitute a major public health problem worldwide, causing important high morbidity and mortality rates. The aim was to present the epidemiology of fragility fractures and to assess the imminent risk of a subsequent fracture and mortality. This is a retrospective population-based cohort study (n = 1369) with a fragility fracture. We estimated the incidence rate of index fragility fractures and obtained information on the subsequent fractures and death during a follow-up of up to three years. We assessed the effect of age, sex, and skeletal site of index fracture as independent risk factors of further fractures and mortality. Incidence rate of index fragility fractures was 86.9/10,000 person-years, with highest rates for hip fractures in women aged ≥80 years. The risk of fracture was higher in subjects with a recent fracture (Relative Risk(RR), 1.80; p < 0.01). Higher age was an independent risk factor for further fracture events. Significant excess mortality was found in subjects aged ≥80 years and with a previous hip fracture (hazard ratio, 3.43 and 2.48, respectively). It is the first study in Spain to evaluate the incidence of major osteoporotic fractures, not only of the hip, and the rate of imminent fracture. Our results provide further evidence highlighting the need for early treatment.

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Duodenoscope-Associated Outbreak of a Carbapenem Resistant Enterobacteriaceae

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.738 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s197-s197

Author(s):

Sung Ran Kim ◽

Joon Young Song ◽

Min Hee Cho ◽

Ji Yeon Song

Keyword(s):

Gel Electrophoresis ◽

Case Control ◽

Pulsed Field Gel Electrophoresis ◽

Control Analysis ◽

Endoscopic Retrograde ◽

Carbapenem Resistant ◽

Case Control Analysis ◽

Record Review ◽

Carbapenem Resistant Enterobacteriaceae ◽

Cleaning Protocol

Background: We describe and evaluate our outbreak of carbapenem-resistant K. pneumoniae transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Methods: An outbreak investigation was performed when Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) were identified from bile specimens of 4 patients. The investigation included medical record review, practice audits, and surveillance cultures of duodenoscopes and environmental sites. If available, clinical specimens were obtained from patients who had undergone ERCP in the previous 3 months. Carbapenem-resistant Enterobacteriaceae (CRE) screening cultures were performed to identify additional patients until no CRE cases were detected during 2 consecutive weeks. Pulsed-field gel electrophoresis (PFGE) of KPC-KP isolates was implemented. Results: In total, 12 cases were identified with exposure to duodenoscope from February 2019 through April 2019, including 6 cases with infections and 6 asymptomatic carriers. Case-control analysis showed that 2 specific duodenoscopes would be associated with the KPC-KP outbreak. Duodenoscope reprocessing procedures did not deviate from manufacturer recommendations for reprocessing. After ethylene oxide (EO) gas sterilization, the outbreak was terminated. Conclusions: Meticulous cleaning protocol and enhanced surveillance are necessary to prevent outbreaks of CRE. Notably, enhanced cleaning measures, such as sterilization for duodenoscopes, would be required after procedures with KPC-KP carriers.Funding: NoneDisclosures: None

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Trajectories and Determinants of Physical Activity during COVID-19 Pandemic: A Population-Based Study of Middle-Aged and Elderly Individuals in The Netherlands

Nutrients ◽

10.3390/nu13113832 ◽

2021 ◽

Vol 13 (11) ◽

pp. 3832

Author(s):

Amy Hofman ◽

Marlou A. M. Limpens ◽

Tosca O. E. de Crom ◽

Mohammad Arfan Ikram ◽

Annemarie I. Luik ◽

...

Keyword(s):

Physical Activity ◽

The Netherlands ◽

Latent Class ◽

Multinomial Logistic Regression ◽

Public Health Problem ◽

Population Based ◽

World Health ◽

Major Public Health Problem ◽

Middle Aged ◽

Health Organization

Physical inactivity is a major public health problem, and there are concerns this might have increased during the COVID-19 pandemic. We aimed to identify distinct trajectories of physical activity over a 6-week period after the first restrictive measures and to explore determinants of these trajectories in a population-based cohort of middle-aged and elderly in the Netherlands (n = 5777). We observed that at least 59% of participants did not meet the World Health Organization recommendations for physical activity. Using latent class trajectory analyses over three time points, we identified five distinct trajectories, including four steady trajectories at different levels (very low, low, medium and high) and one increasing trajectory. Using multinomial logistic regression analyses, we observed that, compared to the ‘steadily high’ trajectory, participants in the ‘steadily very low’ trajectory were more often older, lower educated, reporting poorer physical health, more depressive symptoms, consuming a less healthy diet, smoking, and lower alcohol use, and were less often retired. A similar pattern of determinants was seen for those in the increasing trajectory, albeit with smaller effect sizes. Concluding, we observed low levels of physical activity that generally remained during the pandemic. The determinants we described can help identify groups that require additional preventive interventions.

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Trends and Risk Factors for Antimicrobial-Resistant Neisseria gonorrhoeae, Melbourne, Australia, 2007 to 2018

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01221-19 ◽

2019 ◽

Vol 63 (10) ◽

Cited By ~ 6

Author(s):

Deborah A. Williamson ◽

Christopher K. Fairley ◽

Benjamin P. Howden ◽

Marcus Y. Chen ◽

Kerrie Stevens ◽

...

Keyword(s):

Risk Factors ◽

Neisseria Gonorrhoeae ◽

Laboratory Data ◽

Northeast Asia ◽

Public Health Problem ◽

Multidrug Resistant ◽

International Travel ◽

Major Public Health Problem ◽

Comprehensive Overview ◽

Content Type

ABSTRACT Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health problem. Traditionally, AMR surveillance programs for N. gonorrhoeae have focused mainly on laboratory data to describe the prevalence and trends of resistance. However, integrating individual-level risk factors (e.g., sexual orientation or international travel) with laboratory data provides important insights into factors promoting the spread of resistant N. gonorrhoeae. Here, over a 12-year period, we assessed the trends and risk factors for resistant N. gonorrhoeae in individuals attending a large publicly funded sexual health center in Melbourne, Australia. A total of 7,588 N. gonorrhoeae isolates were cultured from 5,593 individuals between 1 January 2007 and 31 December 2018. The proportion of isolates with penicillin resistance decreased from 49.5% in 2007 to 18.3% in 2018 (ptrend < 0.001) and from 63.5% in 2007 to 21.1% in 2018 for ciprofloxacin resistance (ptrend < 0.001). In contrast, the proportion of isolates displaying decreased susceptibility to ceftriaxone increased from 0.5% in 2007 to 2.9% in 2018 (ptrend < 0.001), with a significant increase in low-level azithromycin resistance, from 2.5% in 2012 to 8.2% in 2018 (ptrend < 0.001). Multivariate analysis identified risk factors for multidrug-resistant (MDR) N. gonorrhoeae, namely, female sex and country of birth, with MDR isolates more common in individuals born in northeast Asia, further highlighting the importance of this region and international travel as factors in the cross-border transmission of MDR N. gonorrhoeae. Future surveillance work should incorporate additional epidemiological and genomic data to provide a comprehensive overview of the emergence and spread of resistant N. gonorrhoeae.

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504. Epidemiology of End-stage Renal Disease (ESRD) Patients with Carbapenem-Resistant Enterobacteriaceae (CRE) Infections: Atlanta Metropolitan Area, 2012–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.573 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S244-S245

Author(s):

Jacqueline M Hurd ◽

Chris W Bower ◽

Jesse T Jacob

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Population Data ◽

Arterial Disease ◽

Population Based ◽

Emerging Infections ◽

Carbapenem Resistant ◽

Stage Renal Disease ◽

End Stage ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background Patients with end-stage renal disease (ESRD) have higher risks for resistant organisms including carbapenem-resistant Enterobacteriaceae (CRE). To explore the effect of ESRD on CRE, we compared characteristics of CRE cases with and without ESRD in a population-based cohort. Methods The Georgia Emerging Infections Program has performed active laboratory- and population-based surveillance for CRE in metropolitan Atlanta (4.1 million in 2017) since 2012. CRE cases are defined by isolation from a sterile body site or urine of E. coli, K. pneumoniae, K. oxytoca, K. aerogenes, or E. cloacae. From 2012 to 2015, cultures were resistant to all third-generation cephalosporins tested and non-susceptible to ≥1 carbapenem (excluding ertapenem). After 2016, cultures were resistant to ≥1 carbapenems. Epidemiologic data including ESRD were collected via medical chart review. ESRD population data were obtained from the US Renal Data System. Georgia vital records data were used to determine 90-day mortality rates. Prevalence estimates were calculated. Comparisons used a χ 2 test. Results Of 1,511 CRE cases, 136 (9%) were on current chronic dialysis, 128 (94%) of which were on hemodialysis (HD) and 5 (4%) were on peritoneal dialysis. Among CRE cases with HD, 94 (73%) had a catheter and 30 (23%) had an arteriovenous fistula or graft. CRE cases with ESRD were more likely to be male (58% vs. 40%), black (76% vs. 38%), and have diabetes (67% vs. 38%), congestive heart failure (25% vs. 17%), or peripheral arterial disease (12% vs. 4%). CRE cases with ESRD had more hospitalizations within 30 days of the culture date (77% vs. 47%), ICU admissions prior to (29% vs. 7%) or after the culture date (43% vs. 14%) and discharges to LTCFs (35% vs. 15%) after hospitalization. CRE cases with ESRD and bacteremia were more likely to have been hospitalized >3 days before the culture compared with CRE cases with ESRD and positive cultures from other body sites (52% vs. 24%). The 90-day mortality rate per 100,000 population was higher among CRE cases with ESRD (100.9 cases) than without ESRD (1.0 cases). Conclusion Among a population-based cohort of patients with CRE infections, ESRD comprised ~10% but had markedly mortality, suggesting that future interventions should target ESRD. Disclosures All authors: No reported disclosures.

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Uncovering Infant Group B Streptococcal (GBS) Disease Clusters in the United Kingdom and Ireland Through Genomic Analysis: A Population-based Epidemiological Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1087 ◽

2020 ◽

Author(s):

Simon M Collin ◽

Natalie Groves ◽

Catherine O’Sullivan ◽

Elita Jauneikaite ◽

Darshana Patel ◽

...

Keyword(s):

Late Onset ◽

Genomic Analysis ◽

Population Based ◽

Difference Threshold ◽

The United Kingdom ◽

Admission Data ◽

True Frequency ◽

Group B ◽

The Uk ◽

Record Review

Abstract Background The true frequency of hospital outbreaks of invasive group B streptococcal (iGBS; Streptococcus agalactiae) disease in infants is unknown. We used whole genome sequencing (WGS) of iGBS isolates collected during a period of enhanced surveillance of infant iGBS disease in the UK and Ireland to determine the number of clustered cases. Methods Potentially linked iGBS cases from infants with early (<7 days of life) or late-onset (7–89 days) disease were identified from WGS data (HiSeq 2500 platform, Illumina) from clinical sterile site isolates collected between 04/2014 and 04/2015. We assessed time and place of cases to determine a single-nucleotide polymorphism (SNP) difference threshold for clustered cases. Case details were augmented through linkage to national hospital admission data and hospital record review by local microbiologists. Results Analysis of sequences indicated a cutoff of ≤5 SNP differences to define iGBS clusters. Among 410 infant iGBS isolates, we identified 7 clusters (4 genetically identical pairs with 0 SNP differences, 1 pair with 3 SNP differences, 1 cluster of 4 cases with ≤1 SNP differences) of which 4 clusters were uncovered for the first time. The clusters comprised 16 cases, of which 15 were late-onset (of 192 late-onset cases with sequenced isolates) and 1 an early-onset index case. Serial intervals between cases ranged from 0 to 59 (median 12) days. Conclusions Approximately 1 in 12 late-onset infant iGBS cases were part of a hospital cluster. Over half of the clusters were previously undetected, emphasizing the importance of routine submission of iGBS isolates to reference laboratories for cluster identification and genomic confirmation.

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Participatory Research for Preventing Pesticide-Related DSH and Suicide in Sundarban, India: A Brief Report

ISRN Psychiatry ◽

10.1155/2013/427417 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Arabinda N. Chowdhury ◽

Sohini Banerjee ◽

Arabinda Brahma ◽

Mrinal K. Biswas

Keyword(s):

Participatory Research ◽

Community Based Participatory Research ◽

Public Health Problem ◽

Local Context ◽

Major Public Health Problem ◽

Group Discussions ◽

Mortality And Morbidity ◽

Agricultural Community ◽

Admission Data ◽

And Training

Deliberate self-harm (DSH) is a major public health problem in the Sundarban region, India. This study is aimed to develop a DSH-suicide prevention programme based on the principles of community-based participatory research (CBPR). Perception and opinion of community about the problem of pesticide-related DSH and suicide were elicited in a series of facilitated focus group discussions in Namkhana block of Sundarban region. Based on their suggestion, a broad preventive programme was launched involving the development of information, education, and communication (IEC) and training modules and training of the stakeholders of the block. Most of the members of each target group found that the IEC materials were culture fair (message is acceptable, understandable, and meaningful in the local context) and very useful. Analysis of Dwariknagar BPHC, DSH admission data showed a definite reduction of DSH incidents after this CBPR approach to prevention was initiated. Similar model of DSH prevention in the other blocks of Sundarban region or in agricultural community may help to reduce the enormous mortality and morbidity from pesticide-related DSH and suicide.

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Analysis of in-hospital mortality among people with and without Diabetes in Australian Public Hospitals (2014-2017)

10.21203/rs.3.rs-521628/v1 ◽

2021 ◽

Author(s):

Tina Gao ◽

Kingsley E Agho ◽

Milan K Piya ◽

David Simmons ◽

Uchechukwu L Osuagwu

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Age Groups ◽

Public Health Problem ◽

Binary Logistic Regression ◽

Population Based ◽

Public Hospitals ◽

Major Public Health Problem ◽

Factors Associated ◽

Cardiovascular Comorbidities

Abstract Background Diabetes is a major public health problem affecting about 1.4 million Australians, especially in South Western Sydney, a hotspot of diabetes with higher than average rates for hospitalisations. The current understanding of the international burden of diabetes and related complications is poor and there is paucity of data on hospital outcomes and/or what common factors influence mortality rate in people with diabetes in Australia. This study determined in-hospital mortality rate and the factors associated among people with and without diabetes. Methods Retrospective data for 554,421 adult inpatients was extracted from the population-based New South Wales (NSW) Admitted Patient Data over 3 financial years (from 2014-15 to 2016-17). The in-hospital mortality per 1000 admitted persons, standardised mortality ratios (SMR) were calculated. Binary logistic regression was performed, adjusting for potential covariates and co-morbidities for people with and without diabetes over three years. Results Over three years 8.7% (48,038 people) of admissions involved those with diabetes. This increased from 8.4% in 2014-15 to 8.9% in 2016-17 (p = 0.007). Across all age groups, in-hospital mortality rate was significantly greater in people with diabetes (20.6, 95% Confidence intervals CI 19.3–21.9 per 1000 persons) than those without diabetes (11.8, 95%CI 11.5–12.1) and more in men than women (23.1, 95%CI 21.2–25.0 vs 17.9, 95%CI 16.2–19.8) with diabetes. The SMR for those with and without diabetes were 3.13 (95%CI 1.78–4.48) and 1.79 (95%CI 0.77–2.82), respectively. There were similarities in the factors associated with in hospital mortality in both groups including: aged > 54years, men, the widowed, those who stayed longer than 4 days or received intensive care in admission and had respiratory and cardiovascular comorbidities. Conclusions The study found that in-patients with diabetes continue to have higher mortality rates than those without diabetes and the Australian population. Overall, similar factors influenced mortality rate in people with and without diabetes in this region indicating that continued improved management of all inpatients is needed in order to minimise the persistent poor outcomes.

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Clinical management of cUTI, cIAI, and HABP/VABP attributable to carbapenem-resistant Gram-negative infections in Spain

Revista Española de Quimioterapia ◽

10.37201/req/096.2021 ◽

2021 ◽

Author(s):

Ricard Ferrer ◽

María Carmen Fariñas ◽

Emilio Maseda ◽

Miguel Salavert ◽

German Bou ◽

...

Keyword(s):

Clinical Management ◽

Bacterial Pneumonia ◽

Chart Review ◽

Complicated Urinary Tract Infection ◽

Public Health Problem ◽

Major Public Health Problem ◽

Post Discharge ◽

Gram Negative ◽

Carbapenem Resistant ◽

Healthcare Associated

Introduction. Carbapenem-resistant Gram-negative (CRGN) infections are a major public health problem in Spain, often implicated in complicated, healthcare-associated infections that require the use of potentially toxic antibacterial agents of last resort. The objective of this study was to assess the clinical management of complicated infections caused by CRGN bacteria in Spanish hospitals. Methods. The study included: 1) a survey assessing the GN infection and antibacterial susceptibility profile in five participating Spanish hospitals and 2) a non-interventional, retrospective single cohort chart review of 100 patients with complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), or hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia (HABP/VABP) attributable to CRGN pathogens. Results. In the participating hospitals CRGN prevalence was 9.3% amongst complicated infections. In the retrospective cohort, 92% of infections were healthcare-associated, and Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common pathogens. OXA was the most frequently detected carbapenemase type (71.4%). We found that carbapenems were frequently used to treat cUTI, cIAI, HABP/VABP caused by CRGN pathogens. Carbapenem use, particularly in combination with other agents, persisted after confirmation of carbapenem resistance. Clinical cure was 66.0%, mortality during hospitalization 35.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. Conclusion. Our results reflect the high burden and unmet needs associated with the management of complicated infections attributable to CRGN pathogens in Spain and highlight the urgent need for enhanced clinical management of these difficult-to-treat infections.

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