TY - JOUR TI - EUropean prospective cohort study on Enterobacteriaceae showing REsistance to CArbapenems (EURECA): A protocol of a European multicentre observational study AU - Gutiérrez-Gutiérrez, B. AU - Sojo-Dorado, J. AU - Bravo-Ferrer, J. AU - Cuperus, N. AU - De Kraker, M. AU - Kostyanev, T. AU - Raka, L. AU - Daikos, G. AU - Feifel, J. AU - Folgori, L. AU - Pascual, A. AU - Goossens, H. AU - O'Brien, S. AU - Bonten, M.J.M. AU - Rodríguez-Baño, J. AU - EURECA project team JO - BMJ Open Gastroenterology PY - 2017 VL - 7 TODO - 4 SP - null PB - BMJ Publishing Group SN - null TODO - 10.1136/bmjopen-2016-015365 TODO - carbapenem derivative; antiinfective agent, abdominal infection; antibiotic resistance; bloodstream infection; carbapenem resistant Enterobacteriaceae; case control study; clinical protocol; clinical trial; cohort analysis; controlled study; Enterobacteriaceae infection; hospital cost; hospital patient; human; infection risk; length of stay; major clinical study; mortality; nonhuman; observational study; pneumonia; prospective study; Review; urinary tract infection; abdominal infection; bacteremia; bacterial pneumonia; cause of death; Enterobacteriaceae; Enterobacteriaceae infection; Europe; hospitalization; microbial sensitivity test; microbiology; multicenter study; treatment outcome; urinary tract infection, Anti-Bacterial Agents; Bacteremia; Carbapenems; Case-Control Studies; Cause of Death; Cohort Studies; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Europe; Hospitalization; Humans; Intraabdominal Infections; Microbial Sensitivity Tests; Mortality; Pneumonia, Bacterial; Prospective Studies; Treatment Outcome; Urinary Tract Infections TODO - IntroductionThe rapid worldwide spread of carbapenem-resistant Enterobacteriaceae (CRE) constitutes a major challenge. The aim of the EUropean prospective cohort study on Enterobacteriaceae showing REsistance to CArbapenems (EURECA), which is part of the Innovative Medicines Initiative Joint Undertaking (IMI JU) funded COMBACTE-CARE project, is to investigate risk factors for and outcome determinants of CRE infections to inform randomised clinical trial designs and to provide a historical cohort that could eventually be used for future comparisons with new drugs targeting CRE. MethodsA multicentre (50 sites), multinational (11 European countries), analytical observational project was designed, comprising 3 studies. The aims of study 1 (a prospective cohort study) include characterising the features, clinical management and outcomes of hospitalised patients with intra-abdominal infection, pneumonia, complicated urinary tract infections and bloodstream infections caused by CRE (202 patients in each group). The main outcomes will be 30-day all-cause mortality and clinical response. Study 2 (a nested case-control study) will identify the risk factors for target infections caused by CRE; 248 selected patients from study 1 will be matched with patients with carbapenem-susceptible Enterobacteriaceae (1:1) and with hospitalised patients (1:3) and will provide a historical cohort of patients with CRE infections. Study 3 (a matched cohort study) will follow patients in study 2 in order to assess mortality, length of stay and hospital costs associated with CRE. All patients will be followed for 30†days. Different, up-to-date statistical methods will be applied to come to unbiased estimates for all 3 studies. Ethics and disseminationBefore-study sites will be initiated, approval will be sought from appropriate regulatory agencies and local Ethics Committees of Research or Institutional Review Boards (IRBs) to conduct the study in accordance with regulatory requirements. This is an observational study and therefore no intervention in the diagnosis, management or treatment of the patients will be required on behalf of the investigation. Any formal presentation or publication of data collected from this study will be considered as a joint publication by the participating physician(s) and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE) for authorship. Trial registration numberNCT02709408. © 2017 Published by the BMJ Publishing Group Limited. ER -