Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia
Background: Carbapenemase-producing Enterobacterales (CPE) represents a significant threat to global health. This study aimed to characterize clinically and molecularly the CPE isolated from rectal swabs of patients in the intensive care units (ICUs) of a tertiary hospital in Cali, Colombia. Methods...
- Autores:
-
Ospina Galindez, Johann Alexis
Fernández-Pineda, Mónica
Martínez-Buitrago, Ernesto
Bravo, José H.
Matta-Cortés, Lorena
Paredes-Amaya, Claudia C.
- Tipo de recurso:
- Article of investigation
- Fecha de publicación:
- 2024
- Institución:
- Universidad Autónoma de Occidente
- Repositorio:
- RED: Repositorio Educativo Digital UAO
- Idioma:
- eng
- OAI Identifier:
- oai:red.uao.edu.co:10614/16166
- Acceso en línea:
- https://hdl.handle.net/10614/16166
https://doi.org/10.1016/j.heliyon.2024.e33368
https://red.uao.edu.co/
- Palabra clave:
- Carbapenemase-producing Enterobacterales
Antibiotic resistance
Carbapenem-resistant
Klebsiella pneumoniae
Enterobacterias productoras de carbapenemasas
Resistencia a los antibióticos
Resistente a los carbapenémicos
- Rights
- openAccess
- License
- Derechos reservados - Elsevier Ltd., 2024
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| dc.title.eng.fl_str_mv |
Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia |
| dc.title.alternative.spa.fl_str_mv |
Caracterización de Enterobacterales productores de carbapenemasas a partir de hisopados rectales de pacientes en las unidades de cuidados intensivos de un hospital de tercer nivel en Cali-Colombia |
| title |
Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia |
| spellingShingle |
Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia Carbapenemase-producing Enterobacterales Antibiotic resistance Carbapenem-resistant Klebsiella pneumoniae Enterobacterias productoras de carbapenemasas Resistencia a los antibióticos Resistente a los carbapenémicos |
| title_short |
Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia |
| title_full |
Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia |
| title_fullStr |
Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia |
| title_full_unstemmed |
Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia |
| title_sort |
Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia |
| dc.creator.fl_str_mv |
Ospina Galindez, Johann Alexis Fernández-Pineda, Mónica Martínez-Buitrago, Ernesto Bravo, José H. Matta-Cortés, Lorena Paredes-Amaya, Claudia C. |
| dc.contributor.author.none.fl_str_mv |
Ospina Galindez, Johann Alexis Fernández-Pineda, Mónica Martínez-Buitrago, Ernesto Bravo, José H. Matta-Cortés, Lorena Paredes-Amaya, Claudia C. |
| dc.subject.proposal.eng.fl_str_mv |
Carbapenemase-producing Enterobacterales Antibiotic resistance Carbapenem-resistant Klebsiella pneumoniae |
| topic |
Carbapenemase-producing Enterobacterales Antibiotic resistance Carbapenem-resistant Klebsiella pneumoniae Enterobacterias productoras de carbapenemasas Resistencia a los antibióticos Resistente a los carbapenémicos |
| dc.subject.proposal.spa.fl_str_mv |
Enterobacterias productoras de carbapenemasas Resistencia a los antibióticos Resistente a los carbapenémicos |
| description |
Background: Carbapenemase-producing Enterobacterales (CPE) represents a significant threat to global health. This study aimed to characterize clinically and molecularly the CPE isolated from rectal swabs of patients in the intensive care units (ICUs) of a tertiary hospital in Cali, Colombia. Methods: This was a cross-sectional observational study. Rectal swabs from patients admitted to the ICUs were collected. Bacterial identification and carbapenemase production were determined using phenotypic and molecular methods. Demographic and clinical data were extracted from electronic medical records. Results: The study included 223 patients. Thirty-six patients (36/223, 16.14 %) were found to be colonized or infected by CPE. Factors such as prolonged stay in the ICU, previous exposure to carbapenem antibiotics, use of invasive procedures, and admission due to trauma were associated with CPE. Klebsiella pneumoniae (52.5 %) was the most prevalent microorganism, and the dominant carbapenemases identified were KPC (57.8 %) and NDM (37.8 %). Conclusion: Distinguishing carbapenemase subtypes can provide crucial insights for controlling dissemination in ICUs in Cali, Colombia |
| publishDate |
2024 |
| dc.date.issued.none.fl_str_mv |
2024 |
| dc.date.accessioned.none.fl_str_mv |
2025-06-12T19:41:16Z |
| dc.date.available.none.fl_str_mv |
2025-06-12T19:41:16Z |
| dc.type.spa.fl_str_mv |
Artículo de revista |
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http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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Text |
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info:eu-repo/semantics/article |
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http://purl.org/redcol/resource_type/ART |
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info:eu-repo/semantics/publishedVersion |
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http://purl.org/coar/resource_type/c_2df8fbb1 |
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Ospina Galindez, J. A.; Fernández-Pineda, M.; Martínez-Buitrago, E.; Bravo, J. H.; Matta-Cortés, L. y Paredes-Amaya, C. C. (2024). Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia. Heliyon 10(12). https://doi.org/10.1016/j.heliyon.2024.e33368 |
| dc.identifier.uri.none.fl_str_mv |
https://hdl.handle.net/10614/16166 |
| dc.identifier.doi.spa.fl_str_mv |
https://doi.org/10.1016/j.heliyon.2024.e33368 |
| dc.identifier.eissn.spa.fl_str_mv |
24058440 |
| dc.identifier.instname.spa.fl_str_mv |
Universidad Autónoma de Occidente |
| dc.identifier.reponame.spa.fl_str_mv |
Respositorio Educativo Digital UAO |
| dc.identifier.repourl.none.fl_str_mv |
https://red.uao.edu.co/ |
| identifier_str_mv |
Ospina Galindez, J. A.; Fernández-Pineda, M.; Martínez-Buitrago, E.; Bravo, J. H.; Matta-Cortés, L. y Paredes-Amaya, C. C. (2024). Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia. Heliyon 10(12). https://doi.org/10.1016/j.heliyon.2024.e33368 24058440 Universidad Autónoma de Occidente Respositorio Educativo Digital UAO |
| url |
https://hdl.handle.net/10614/16166 https://doi.org/10.1016/j.heliyon.2024.e33368 https://red.uao.edu.co/ |
| dc.language.iso.eng.fl_str_mv |
eng |
| language |
eng |
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8 |
| dc.relation.citationissue.spa.fl_str_mv |
12 |
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1 |
| dc.relation.citationvolume.spa.fl_str_mv |
10 |
| dc.relation.ispartofjournal.eng.fl_str_mv |
Heliyon |
| dc.relation.references.none.fl_str_mv |
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Nagao, Comparison of the Xpert Carba-R and NG-Test CARBA5 for the detection of carbapenemases in an IMP-type carbapenemase endemic region in Japan, J. Infect. Chemother. 27 (2021) 503–506, https://doi.org/10.1016/j.jiac.2020.11.001. [37] L.L. Baeza, N. Pfennigwerth, C. Greissl, S. G¨ottig, A. Saleh, Y. Stelzer, S.G. Gatermann, A. Hamprecht, Comparison of five methods for detection of carbapenemases in Enterobacterales with proposal of a new algorithm, Clin. Microbiol. Infection 25 (2019) e9–e15, https://doi.org/10.1016/j. cmi.2019.03.003 |
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Derechos reservados - Elsevier Ltd., 2024 |
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Derechos reservados - Elsevier Ltd., 2024 https://creativecommons.org/licenses/by-nc-nd/4.0/ Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0) http://purl.org/coar/access_right/c_abf2 |
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Ospina Galindez, Johann Alexisvirtual::6090-1Fernández-Pineda, MónicaMartínez-Buitrago, ErnestoBravo, José H.Matta-Cortés, LorenaParedes-Amaya, Claudia C.2025-06-12T19:41:16Z2025-06-12T19:41:16Z2024Ospina Galindez, J. A.; Fernández-Pineda, M.; Martínez-Buitrago, E.; Bravo, J. H.; Matta-Cortés, L. y Paredes-Amaya, C. C. (2024). Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-Colombia. Heliyon 10(12). https://doi.org/10.1016/j.heliyon.2024.e33368https://hdl.handle.net/10614/16166https://doi.org/10.1016/j.heliyon.2024.e3336824058440Universidad Autónoma de OccidenteRespositorio Educativo Digital UAOhttps://red.uao.edu.co/Background: Carbapenemase-producing Enterobacterales (CPE) represents a significant threat to global health. This study aimed to characterize clinically and molecularly the CPE isolated from rectal swabs of patients in the intensive care units (ICUs) of a tertiary hospital in Cali, Colombia. Methods: This was a cross-sectional observational study. Rectal swabs from patients admitted to the ICUs were collected. Bacterial identification and carbapenemase production were determined using phenotypic and molecular methods. Demographic and clinical data were extracted from electronic medical records. Results: The study included 223 patients. Thirty-six patients (36/223, 16.14 %) were found to be colonized or infected by CPE. Factors such as prolonged stay in the ICU, previous exposure to carbapenem antibiotics, use of invasive procedures, and admission due to trauma were associated with CPE. Klebsiella pneumoniae (52.5 %) was the most prevalent microorganism, and the dominant carbapenemases identified were KPC (57.8 %) and NDM (37.8 %). Conclusion: Distinguishing carbapenemase subtypes can provide crucial insights for controlling dissemination in ICUs in Cali, ColombiaLas enterobacterias productoras de carbapenemasas (CPE) se encuentran entre los problemas de salud pública más importantes a nivel mundial. Las infecciones causadas por CPE conllevan hospitalizaciones más prolongadas, mayores costos de atención médica y tasas de mortalidad más altas que las infecciones causadas por cepas sensibles a carbapenémicos [ 1 , 2 ]. Desde el primer aislamiento de Klebsiella pneumoniae resistente a carbapenémicos en 1996, las carbapenemasas se han convertido en un importante problema de salud pública [ 3 ]. Las carbapenemasas son enzimas que hidrolizan los antibióticos betalactámicos, incluidos los carbapenémicos . Se han descrito varios tipos de enzimas a lo largo de los años, como la carbapenemasa de Klebsiella pneumoniae (KPC), la metalobetalactamasa de Nueva Delhi (NDM), la metalobetalactamasa codificada por integrón de Verona (VIM), la metalobetalactamasa de imipenemasa (IMP) y la oxacilinasa (OXA)-48, que son los tipos más relevantes en entornos clínicos [ 4 , 5 ]. En Colombia, las bacterias productoras de KPC comenzaron a propagarse a finales de la década de 2000 [ 6 ]. La prevalencia de CPE en Colombia varía ampliamente, con tasas reportadas de 1 % para Escherichia coli , 23 % para K. pneumoniae y 60 % para Providencia rettgeri [ 7 ]. La relevancia clínica de estas bacterias radica principalmente en las graves infecciones que pueden causar [ 8 ]. Según datos publicados por el Instituto Nacional de Salud en Colombia, alrededor del 10 % de CPE y Pseudomonas aeruginosa productoras de carbapenemasas expresan más de una clase distinta de estas enzimas simultáneamente [ 9 ]. Esto representa un desafío diagnóstico significativo ya que las pruebas fenotípicas utilizadas en la mayoría de los laboratorios colombianos no pueden detectar estas coproducciones [ 10 ]. La KPC, que se está expandiendo globalmente, se ha vuelto endémica en América del Sur, y Colombia se ha convertido en un foco importante [ 11 ]. Esta diseminación generalizada de bacilos gramnegativos multirresistentes (MDR), especialmente Enterobacterales y bacilos no fermentadores como Pseudomonas spp. y Acinetobacter spp. , cuando se asocia con cualquier infección, actúa como un factor contribuyente significativo al aumento de los costos de atención médica, las estadías hospitalarias prolongadas y las tasas de mortalidad elevadas [ 10 , 12 ]. Sigue siendo un desafío persistente para el sistema de atención médica. En Colombia, existen pocos reportes sobre la caracterización genética de ECP, especialmente en unidades de cuidados intensivos para adultos (UCI), y no está claro si están relacionados clonalmente por descendencia [ 9 ]. El objetivo de este estudio fue caracterizar clínica y molecularmente los ECP aislados de hisopos rectales de pacientes en las UCI de un hospital terciario en Cali, Colombia8 páginasapplication/pdfengScienceDirectSuizaDerechos reservados - Elsevier Ltd., 2024https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessAtribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)http://purl.org/coar/access_right/c_abf2Characterization of carbapenemase-producing Enterobacterales from rectal swabs of patients in the intensive care units of a tertiary hospital in Cali-ColombiaCaracterización de Enterobacterales productores de carbapenemasas a partir de hisopados rectales de pacientes en las unidades de cuidados intensivos de un hospital de tercer nivel en Cali-ColombiaArtículo de revistahttp://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/version/c_970fb48d4fbd8a85Cali, Colombia812110Heliyon[1] S.M. Bartsch, J.A. McKinnell, L.E. Mueller, L.G. Miller, S.K. Gohil, S.S. Huang, B.Y. Lee, Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States, Clin. Microbiol. Infection 23 (2017) e9–e16, https://doi.org/10.1016/j.cmi.2016.09.003.[2] J.D. Lutgring, Carbapenem-resistant Enterobacteriaceae: an emerging bacterial threat, Semin. Diagn. Pathol. 36 (2019) 182–186, https://doi.org/10.1053/j. semdp.2019.04.011.[3] H. Yigit, A.M. Queenan, G.J. Anderson, A. Domenech-Sanchez, J.W. Biddle, C.D. Steward, S. Alberti, K. Bush, F.C. Tenover, Novel carbapenem-Hydrolyzing β-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae, Antimicrob. Agents Chemother. 45 (2001) 1151–1161, https://doi.org/ 10.1128/AAC.45.4.1151-1161.2001.[4] Y.L. Lee, H.M. Chen, I.M. Hii, P.R. Hsueh, Carbapenemase-producing Enterobacterales infections: recent advances in diagnosis and treatment, Int. J. Antimicrob. Agents 59 (2022) 106528, https://doi.org/10.1016/J.IJANTIMICAG.2022.106528.[5] O. Khokhlova, A. Kislichkina, O. Caliskan-Aydogan, E.C. Alocilja, A review of carbapenem resistance in Enterobacterales and its detection techniques, Microorganisms 11 (2023) 1491, https://doi.org/10.3390/MICROORGANISMS11061491, 11 (2023) 1491.[6] G. Esparza, Bacterias Gram negativas resistentes a carbapenemicos en Colombia: un desafío continuo al sistema de salud, Infectio 24 (2020) 55, https://doi.org/ 10.22354/in.v24i2.831.[7] J.A. Cort´es, A.L. Leal, G. Mu˜net´on-L´opez, J.S. Bravo-Ojeda, L.C. N´ocua-B´aez, V. Avila, E. Silva, C.A. ´Alvarez-Moreno, P. Espitia, S.M. Gualtero, S.L. Valderrama, F.O. Guevara, G. Esparza, C.H. Saavedra, J.A. Díaz, M.C. Valderrama-Ríos, Clinical practice guideline for screening of patients at risk of colonization by carbapenemase-producing Enterobacterales and the treatment of infections caused by these bacteria, Revista de La Facultad de Medicina 69 (2021) e90140, https://doi.org/10.15446/revfacmed.v69n3.90140.[8] M. Tilahun, Y. kassa, A. Gedefie, M.A. Belete, Emerging carbapenem-resistant enterobacteriaceae infection, its epidemiology and novel treatment options: a review, Infect. Drug Resist. 14 (2021) 4363–4374, https://doi.org/10.2147/IDR.S337611.[9] M.V. Ovalle, S.Y. Saavedra, M.N. Gonz´alez, A.M. Hidalgo, C. Duarte, M. Beltr´an, Results of the national surveillance of antimicrobial resistance of Enterobacteriaceae and Gram negative bacilli in health care-associated infections in Colombia, 2012-2014, Biomedica 37 (2017) 473, https://doi.org/10.7705/ biomedica.v37i4.3432.[10] M.V. Villegas, A. Jim´enez, G. Esparza, T.M. Appel, Carbapenemase-producing Enterobacteriaceae: a diagnostic, epidemiological and therapeutic challenge, Infectio 23 (2019) 388, https://doi.org/10.22354/in.v23i4.808.[11] L.S. Tzouvelekis, A. Markogiannakis, M. Psichogiou, P.T. Tassios, G.L. Daikos, Carbapenemases in Klebsiella pneumoniae and other enterobacteriaceae: an evolving crisis of global dimensions, Clin. Microbiol. Rev. 25 (2012) 682–707, https://doi.org/10.1128/CMR.05035-11.[12] M. Bar Ilan, A. Kjerulf, Who should be screened for carbapenemase-producing Enterobacterales and when? A systematic review, J. Hosp. Infect. 142 (2023) 74–87, https://doi.org/10.1016/j.jhin.2023.09.018.[13] M02-A12 performance standards for antimicrobial disk susceptibility tests; approved standard-twelfth edition. www.clsi.org, 2015.[14] L. Poirel, T.R. Walsh, V. Cuvillier, P. Nordmann, Multiplex PCR for detection of acquired carbapenemase genes, Diagn. Microbiol. Infect. 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Parra Ramírez, V. Korten, H. Bilgin, G.N. Dalekos, A. Stefos, N. Spyridis, A. Michos, F.G. De Rosa, R. Cavallo, N. Petrosillo, A. Dicaro, M. P. Landini, M.L. Ciofi degli Atti, M. Masanovic, D. Matkovic, S. Tsiodras, F. Blasi, M. Di pasquale, C. Viscoli, A. Vata, O. Dorneanu, P. Kapisyzi, A. Vince, E. Tsigou, E. Maltezos, A. Komnos, C. Gogos, F. Franzetti, M. Antonelli, M. Lupse, D. Corneci, D. Tomescu, A. Georgescu, L. Bukarica, G. Mitrovi´c, N.L. Krsti´c, A. Kurti, B. Díaz-Poll´an, J.O. Sabater, P. Mu˜noz, A. Azap, B. Sancak, A. Sahin, H. Akalin, Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA), EClinicalMedicine 57 (2023) 101871, https://doi.org/10.1016/j. eclinm.2023.101871. [21] J. Diego Velez, M. Orrego, S. Montes, E. Tafur, C.M. Parra, A. Castro, A. Milena Ruiz, N. Guarin, F. Rosso, 541. Factors associated with the persistence of colonization by multidrug-resistant organisms in Cali, Colombia, Open Forum Infect. Dis. 6 (2019) S258–S258. https://doi.org/10.1093/ofid/ofz360.610.[22] P. Ciobotaro, M. Oved, E. Nadir, R. Bardenstein, O. Zimhony, An effective intervention to limit the spread of an epidemic carbapenem-resistant Klebsiella pneumoniae strain in an acute care setting: from theory to practice, Am. J. Infect. Control 39 (2011) 671–677, https://doi.org/10.1016/j.ajic.2011.05.004.[23] L.K. Logan, R.A. Weinstein, The epidemiology of carbapenem-resistant enterobacteriaceae: the impact and evolution of a global menace, J. Infect. Dis. 215 (2017) S28–S36, https://doi.org/10.1093/infdis/jiw282.[24] L.J. Rojas, M.F. Mojica, V.M. Blanco, A. Correa, M.C. Montealegre, E. De La Cadena, J.J. Maya, R.D. Camargo, J.P. Quinn, M.V. Villegas, Emergence of Klebsiella pneumoniae coharboring KPC and VIM carbapenemases in Colombia, Antimicrob. Agents Chemother. 57 (2013) 1101–1102, https://doi.org/10.1128/ AAC.01666-12.[25] G.R. Thomas, A. Corso, F. Paster´an, J. Shal, A. Sosa, M. Pillonetto, R.T. de Souza Peral, J.C. Hormaz´abal, P. Araya, S.Y. Saavedra, M.V. Ovalle, M.A. Jim´enez Pearson, G.C. Chac´on, E. Carbon, C.J. Mazariegos Herrera, G. Vel´asquez, C. Satan-Salazar, F. Villavicencio, N.M. Touchet, S. Busignani, M. Mayta-Barrios, J. Ramírez-Illescas, M.L. Vega, C. Mogdasy, V. Rosas, N. Salgado, R. Quiroz, N. El-Omeiri, M.F. Galas, P. Ram´on-Pardo, R.G. Melano, Increased detection of carbapenemase-producing Enterobacterales bacteria in Latin America and the caribbean during the COVID-19 pandemic, Emerg. Infect. Dis. 28 (2022) 1–8, https://doi.org/10.3201/eid2811.220415.[26] Instituto Nacional de Salud, Resultados de la vigilancia por Laboratorios e resistencia antimicrobiana en Infecciones Asociadas a la Atenci´on en Salud, 2023. Colombia, Bogot´a.[27] G. Bianco, M. Boattini, S. Comini, R. Casale, M. Iannaccone, R. Cavallo, C. Costa, Occurrence of multi-carbapenemases producers among carbapenemaseproducing Enterobacterales and in vitro activity of combinations including cefiderocol, ceftazidime-avibactam, meropenem-vaborbactam, and aztreonam in the COVID-19 era, Eur. J. Clin. Microbiol. Infect. Dis. 41 (2022) 573–580, https://doi.org/10.1007/s10096-022-04408-5.[28] V. Ball´en, Y. Gabasa, C. Ratia, R. Ortega, M. Tejero, S. Soto, Antibiotic resistance and virulence profiles of Klebsiella pneumoniae strains isolated from different clinical sources, Front. Cell. Infect. Microbiol. 11 (2021), https://doi.org/10.3389/FCIMB.2021.738223.[29] M. Teresa, D. Rocca, F. Foglia, V. Crudele, G. Greco, A. De Filippis, G. Franci, E. Finamore, M. Galdiero, Antimicrobial resistance changing trends of Klebsiella pneumoniae isolated over the last 5 years, New Microbiol. 45 (2022) 338–343. http://www.eucast.org/clinical_break. (Accessed 8 December 2023).[30] S. Hughes, M. Gilchrist, K. Heard, R. Hamilton, J. Sneddon, Treating infections caused by carbapenemase-producing Enterobacterales (CPE): a pragmatic approach to antimicrobial stewardship on behalf of the UKCPA Pharmacy Infection Network (PIN), JAC Antimicrob Resist 2 (2020), https://doi.org/10.1093/ jacamr/dlaa075.[31] Suay-García, P´erez-Gracia, Present and future of carbapenem-resistant enterobacteriaceae (CRE) infections, Antibiotics 8 (2019) 122, https://doi.org/10.3390/ antibiotics8030122.[32] G. Bianco, M. Boattini, S. Comini, A. Leone, A. Bondi, T. Zaccaria, R. Cavallo, C. Costa, Implementation of Chromatic Super CAZ/AVI® medium for active surveillance of ceftazidime-avibactam resistance: preventing the loop from becoming a spiral, Eur. J. Clin. Microbiol. Infect. Dis. (2022), https://doi.org/ 10.1007/s10096-022-04480-x.[33] G. Bianco, M. Boattini, M. Iannaccone, A. Bondi, D. Ghibaudo, E. Zanotto, M. Peradotto, R. Cavallo, C. 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