Population-Based Co-infection of Carbapenem-Resistant Organisms and SARS-CoV-2 in Massachusetts

ABSTRACT

Background. Concerns about antibiotic resistance are exacerbated in COVID-19 patients due to frequent antibiotic use, increase in mechanical ventilation and reusable equipment, conservation of PPE, and strain on hospital staff. We described cases with co-infection of carbapenem-resistant organisms (CRO) and SARS-CoV-2 and compared rates in the Massachusetts population. Methods. All providers and hospitals are required to report CROs and SARS-CoV-2 to the Massachusetts Virtual Epidemiologic Network (MAVEN). We selected cases with both a positive SARS-CoV-2 test and a laboratory confirmed CRO from January through July 2020. We classified by which result occurred first and described demographic and clinical characteristics. We standardized the CRO case definition by excluding CR-Pseudomonas aeruginosa and calculated rates per 100,000 to assess the impact of SARS-CoV-2 on the population-based frequency of CROs. Analyses were conducted in SAS 9.4. Results. 28 confirmed cases of SARS-CoV-2 infection were also diagnosed with a CRO. They were an average age of 71.8, 60.7% male, 67.9% white, and 64.3% were in congregate care prior to their diagnoses. Mortality was 5/28 (17.9%). The 23 (82.1%) with a positive SARS-CoV-2 result first were all hospitalized at least once compared to 40% in the CRO first group (p=0.003). 11 (47.8%) of the SARS-CoV-2 first were already admitted when they tested CRO positive;7 (30.4%) were admitted for the CRO separately from COVID-19 treatment. None of the CRO first group were admitted for CRO infection. Average length of stay for the SARS-CoV-2 first group was higher than the CRO first group (62.3 days vs 11.0 days;p=0.049). Cases positive for CRO first were all infected with CR-Escherichia coli whereas those positive for SARS-CoV-2 first were infected with CRAB, CRPA, or a CRE (Klebsiella oxytoca or Klebsiella pneumoniae) (p< 0.0001). The rate of CRO/COVID coinfection was 0.203 per 100,000 population;the rates for January through July of CRO alone were 2.5 per 100,000 in 2020 and 2.4 per 100,000 in 2019. Conclusion. Characteristics of individuals co-infected with CRO and SARSCoV-2 differed by which diagnosis was made first;however, the SARS-CoV-2 pandemic did not impact the CRO population rate during the time frame studied.