ABSTRACT
Concomitant prevention of SARS-CoV-2 and extensively drug-resistant bacteria transmission is a difficult challenge in intensive care units dedicated to COVID-19 patients. We report a nosocomial cluster of four patients carrying NDM-1 plasmid-encoded carbapenemase-producing Enterobacter cloacae. Two main factors may have contributed to cross-transmission: misuse of gloves and absence of change of personal protective equipment, in the context of COVID-19-associated shortage. This work highlights the importance of maintaining infection control measures to prevent CPE cross-transmission despite the difficult context and that this type of outbreak can potentially involve several species of Enterobacterales.
Subject(s)
Carbapenem-Resistant Enterobacteriaceae/isolation & purification , Coinfection/epidemiology , Cross Infection/epidemiology , Enterobacter cloacae/isolation & purification , Enterobacteriaceae Infections/epidemiology , Infection Control/methods , Bacterial Proteins , COVID-19 , Carbapenem-Resistant Enterobacteriaceae/genetics , Disease Outbreaks , Enterobacter cloacae/genetics , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae Infections/transmission , Humans , Intensive Care Units , Personal Protective Equipment , SARS-CoV-2 , beta-LactamasesABSTRACT
Here we report on seven intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) who developed positive rectal swabs and invasive infections due to carbapenemase-producing Klebsiella pneumoniae (CP-Kp). Notwithstanding the infection prevention measures introduced during the COVID-19 pandemic and changes in the hospitalised population, attention to CP-Kp infections must remain high, especially in the critically ill setting.
Subject(s)
COVID-19/microbiology , Carbapenem-Resistant Enterobacteriaceae/isolation & purification , Klebsiella Infections/virology , Klebsiella pneumoniae/isolation & purification , Adult , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Coinfection/epidemiology , Critical Illness , Female , Humans , Intensive Care Units/statistics & numerical data , Italy/epidemiology , Klebsiella Infections/epidemiology , Klebsiella Infections/microbiology , Klebsiella Infections/therapy , Male , Middle Aged , SARS-CoV-2/isolation & purificationABSTRACT
BACKGROUND: Patients with COVID-19 may be at increased risk for secondary bacterial infections with MDR pathogens, including carbapenemase-producing Enterobacterales (CPE). OBJECTIVES: We sought to rapidly investigate the clinical characteristics, population structure and mechanisms of resistance of CPE causing secondary infections in patients with COVID-19. METHODS: We retrospectively identified CPE clinical isolates collected from patients testing positive for SARS-CoV-2 between March and April 2020 at our medical centre in New York City. Available isolates underwent nanopore sequencing for rapid genotyping, antibiotic resistance gene detection and phylogenetic analysis. RESULTS: We identified 31 CPE isolates from 13 patients, including 27 Klebsiella pneumoniae and 4 Enterobacter cloacae complex isolates. Most patients (11/13) had a positive respiratory culture and 7/13 developed bacteraemia; treatment failure was common. Twenty isolates were available for WGS. Most K. pneumoniae (16/17) belonged to ST258 and encoded KPC (15 KPC-2; 1 KPC-3); one ST70 isolate encoded KPC-2. E. cloacae isolates belonged to ST270 and encoded NDM-1. Nanopore sequencing enabled identification of at least four distinct ST258 lineages in COVID-19 patients, which were validated by Illumina sequencing data. CONCLUSIONS: While CPE prevalence has declined substantially in New York City in recent years, increased detection in patients with COVID-19 may signal a re-emergence of these highly resistant pathogens in the wake of the global pandemic. Increased surveillance and antimicrobial stewardship efforts, as well as identification of optimal treatment approaches for CPE, will be needed to mitigate their future impact.