ESKAPE and Beyond: The Burden of Coinfections in the COVID-19 Pandemic

Abstract

The ESKAPE group constitute a threat to public health, since these microorganisms are associated with severe infections in hospitals and have a direct relationship with high mortality rates. The presence of these bacteria in hospitals had a direct impact on the incidence of healthcare-associated coinfections in the SARS-CoV-2 pandemic. In recent years, these pathogens have shown resistance to multiple antibiotic families. The presence of high-risk clones within this group of bacteria contributes to the spread of resistance mechanisms worldwide. In the pandemic, these pathogens were implicated in coinfections in severely ill COVID-19 patients. The aim of this review is to describe the main microorganisms of the ESKAPE group involved in coinfections in COVID-19 patients, addressing mainly antimicrobial resistance mechanisms, epidemiology, and high-risk clones.

Gram-Negative ESKAPE Bacteria Surveillance in COVID-19 Pandemic Exposes High-Risk Sequence Types of Acinetobacter baumannii MDR in a Tertiary Care Hospital

“…In 2008, Rice first coined the acronym ESKAPE for a group of bacteria that in addition to being multidrug-resistant by "escaping antimicrobial therapy", it was observed that it was a group of bacteria prevalent as causative agents of healthcare-associated infections (HAIs). This observation, which was not so obvious to many, served to focus the attention of several hospital centers around the world on this group of microorganisms, calling them "ESKAPE pathogens" [1][2][3][4][5][6][7]. During the COVID-19 pandemic, this bacterial group was one of the main agents causing co-infections in critically ill patients, where ventilator-associated pneumonia (VAP) was the most important HAI due to the drug resistance identified in these isolates, as well as a generator of hospital outbreaks [8][9][10].…”

COVID-19 Pandemic Modulates the Environmental Contamination Level with Enteric Bacteria from WWTPs

“…Aquatic environments under anthropic pressure are hot spots for antibiotics and antibiotic resistance genes. In addition to them, municipal WWTPs are also major incubators for stimulating bacterial resistance mechanisms due to the fact that most antibiotics used in medical systems are excreted, via urine and feces, into sewage systems [13].…”

“…Recent studies showed the presence of the same Klebsiella pneumonia clone in both hospital and WWTP influents and effluents after chlorination, suggesting a high adaptive potential of this clone [16]. The majority of fecal bacteria strains, such as Klebsiella pneumonia, isolated from effluents, influents and clinical samples were multidrug resistant, and they were especially resistant to antibiotics (beta-lactams) [13]. Unfortunately, the microbiological and pharmaceutical compound presence in sewage systems through excreted feces from people with infections were not significantly reduced by the WWTPs; therefore, they could reach and contaminate the environment, including the human communities nearby [17].…”

A statistical approach to enhance the productivity of Streptomyces baarensis MH-133 for bioactive compounds

“…High mortality rates and severe infections are directly attributable to the fact that the majority of these microorganisms are capable of surviving in the hospital environment via biofilm formation or the capacity to withstand stress conditions (e.g., the presence of disinfectants). The prevalence of healthcare-associated coinfections has been significantly influenced by the establishment of these pathogens in hospitals in recent times, amidst the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic [ 4 ] . Additionally, antibiotic resistance has a huge economic effect, with estimates indicating that it might cost the world economy up to $100 trillion by 2050 [ 5 ].…”