A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit

Abstract

Background Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. Methods Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). Results WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. Conclusions Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.

The interface between COVID-19 and bacterial healthcare-associated infections

“…( 30 , 31 ) The spread of VRE to COVID-19 patients in a healthcare setting has been demonstrated through the application of WGS in work conducted at the University Hospital Münster in Germany. ( 32 ) The researchers detected clonally-related isolates of VRE in both ICU patients and in environmental samples indicating a role for contaminated surfaces in VRE transmission to COVID-19 patients. ( 32 ).…”

“…( 32 ) The researchers detected clonally-related isolates of VRE in both ICU patients and in environmental samples indicating a role for contaminated surfaces in VRE transmission to COVID-19 patients. ( 32 ).…”

Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance?

“…While experts have warned of the link between COVID-19 and AMR [ 3 - 8 ], studies report conflicting evidence. Several studies—from, in particular, Germany, Italy and the US—have reported outbreaks or an increase in infections with and/or acquisition of multidrug-resistant bacteria during the COVID-19 pandemic [ 9 - 12 ]. Further studies have reported cases of antimicrobial-resistant invasive fungal infections in COVID-19 patients [ 13 , 14 ], and one case of azole-resistant Aspergillus spp.…”

Antimicrobial TiO2 nanocomposite coatings for surfaces, dental and orthopaedic implants

“…Experts have already warned about the link of COVID-19 and antibiotic-resistant microbes [141] , [142] . Few countries have reported an increased number of cases related to multi-drug resistant microbes during the COVID-19 pandemic [141] , [143] , [144] , [145] , [146] . The execution of light-active TiO 2 coatings is an outstanding option to fight against the antibiotic-resistant strains developed in several environments such as shared touch surfaces, healthcare environments, water resources, agriculture, food, etc .…”