Increased Detection of Carbapenemase-Producing Enterobacterales Bacteria in Latin America and the Caribbean during the COVID-19 Pandemic

Thomas, Genara Romero; Corso, Alejandra; Pasterán, Fernando; Shal, Justina; Sosa, Aldo; Pillonetto, Marcelo; Peral, Renata Tigulini de Souza; Hormázabal, Juan Carlos; Araya, Pamela; Saavedra, Sandra Yamile; Ovalle, María Victoria; Pearson, María Antonieta Jiménez; Chacón, Grettel Chanto; Carbon, Eric; Herrera, Carmen Julia Mazariegos; Velásquez, Selene Del Carmen González; Satan-Salazar, Carolina; Villavicencio, Fernando; Touchet, Nancy Melgarejo; Busignani, Sofía; Mayta-Barrios, Maritza; Ramírez-Illescas, Juan; Vega, Mariana López; Mogdasy, Cristina; Rosas, Verónica Mundo; Salgado, Nuris; Quiroz, Rodolfo; El-Omeiri, Nathalie; Galas, Marcelo; Ramón-Pardo, Pilar; Melano, Roberto G.

doi:10.3201/eid2811.220415

Cited by 48 publications

(40 citation statements)

References 40 publications

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“…[8][9][10] Reports showing an increase in AMR in Latin America after the pandemic are emerging. 16 This finding mirrors a rise of AMR in the United States, where nosocomial infections by ESBL increased by 32%, CRE increased by 35% and AMR PSAR increased by 132% in the first year of the pandemic. 11 Excess antibiotic use is a significant problem in LMICs.…”

Section: Resultsmentioning

confidence: 72%

Antimicrobial resistance in Escherichia coli and Pseudomonas aeruginosa before and after the coronavirus disease 2019 (COVID-19) pandemic in the Dominican Republic

Lora

Sorondo²,

Billini³

et al. 2022

ASHE

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Objective: To describe antimicrobial resistance before and after the COVID-19 pandemic in the Dominican Republic. Design: Retrospective study. Setting: The study included 49 outpatient laboratory sites located in 13 cities nationwide. Participants: Patients seeking ambulatory microbiology testing for urine and bodily fluids Methods: We reviewed antimicrobial susceptibility reports for Escherichia coli isolates from urine and Pseudomonas aeruginosa (PSAR) from bodily fluids between January 1, 2018, to December 31, 2021, from deidentified susceptibility data extracted from final culture results. Results: In total, 27,718 urine cultures with E. coli and 2,111 bodily fluid cultures with PSAR were included in the analysis. On average, resistance to ceftriaxone was present in 25.19% of E. coli isolated from urine each year. The carbapenem resistance rates were 0.15% for E. coli and 3.08% for PSAR annually. The average rates of E. coli with phenotypic resistance consistent with possible extended-spectrum β-lactamase (ESBL) in urine were 25.63% and 24.75%, respectively, before and after the COVID-19 pandemic. The carbapenem resistance rates in urine were 0.11% and 0.20%, respectively, a 200% increase. The average rates of PSAR with carbapenem resistance in bodily fluid were 2.33% and 3.84% before and after the COVID-19 pandemic, respectively, a 130% percent increase. Conclusions: Resistance to carbapenems in PSAR and E. coli after the COVID-19 pandemic is rising. These resistance patterns suggest that ESBL is common in the Dominican Republic. Carbapenem resistance was uncommon but increased after the COVID-19 pandemic.

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Section: Resultsmentioning

confidence: 72%

Antimicrobial resistance in Escherichia coli and Pseudomonas aeruginosa before and after the coronavirus disease 2019 (COVID-19) pandemic in the Dominican Republic

Lora

Sorondo²,

Billini³

et al. 2022

ASHE

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“…Fifty-seven patients were admitted in Period 1 (18.3%) and 254 in Period 2 (81.7%) (Figure 1). The median age was 63 years (53-71), the male patients were 159 (51.1%), and the median SAPS II score was 29 (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). The main registered comorbidities were diabetes mellitus (40.8%) and arterial hypertension (62.1%).…”

Section: Resultsmentioning

confidence: 99%

“…In this context, the risk of bacterial crosstransmission was thought unlikely to occur. However, massive dissemination of resistant bacteria was observed in some ICUs [27]. This was explained by the increased workload, the heaviness of the care in particular, the need to change positions (prone and supine position), and the use of replacement professionals less or not qualified to compensate for absences and resignations.…”

Section: Discussionmentioning

confidence: 99%

Impact of Antibiotic Consumption on the Acquisition of Extended-Spectrum β-Lactamase Producing Enterobacterales Carriage during the COVID-19 Crisis in French Guiana

et al. 2022

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(1) Background: During the COVID-19 outbreak, several studies showed an increased prevalence of extended-spectrum β-lactamase producing Enterobacterales (ESBL-PE) carriage in intensive care units (ICUs). Our objective was to assess the impact of antibiotic prescriptions on the acquisition of ESBL-PE in ICUs during the COVID-19 crisis. (2) Methods: We conducted an observational study between 1 April 2020, and 31 December 2021, in the medical-surgical ICU of the Cayenne General Hospital. We defined two periods: Period 1 with routine, empirical antibiotic use, and Period 2 with no systematic empiric antibiotic prescription. (3) Results: ICU-acquired ESBL-PE carriage was 22.8% during Period 1 and 9.4% during Period 2 (p = 0.005). The main isolated ESBL-PE was Klebsiella pneumoniae (84.6% in Period 1 and 58.3% in Period 2). When using a generalized linear model with a Poisson family, exposure to cefotaxime was the only factor independently associated with ESBL-PE acquisition in ICU (p = 0.002, IRR 2.59 (95% IC 1.42–4.75)). The propensity scores matching estimated the increased risk for cefotaxime use to acquire ESBL-PE carriage at 0.096 (95% CI = 0.02–0.17), p = 0.01. (4) Conclusions: Exposure to cefotaxime in patients with severe COVID-19 is strongly associated with the emergence of ESBL-PE in the context of maximal infection control measures.

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“…This data is concerning since this microorganism may become frequently resistant and constitutes a challenging pathogen to treat, especially in countries with limited resources and no new antibiotics being widely available. It is important to highlight that Klebsiella pneumoniae has been highly reported in patients with COVID-19 in Latin America 33 , 34 . Interestingly, the prevalence of Acinetobacter baumannii was particularly higher in Latin America, which is also concerning.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study

Reyes

Fuentes

Duque

et al. 2023

Sci Rep

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Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40–2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98–1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.

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Increased Detection of Carbapenemase-Producing Enterobacterales Bacteria in Latin America and the Caribbean during the COVID-19 Pandemic

Cited by 48 publications

References 40 publications

Antimicrobial resistance in Escherichia coli and Pseudomonas aeruginosa before and after the coronavirus disease 2019 (COVID-19) pandemic in the Dominican Republic

Antimicrobial resistance in Escherichia coli and Pseudomonas aeruginosa before and after the coronavirus disease 2019 (COVID-19) pandemic in the Dominican Republic

Impact of Antibiotic Consumption on the Acquisition of Extended-Spectrum β-Lactamase Producing Enterobacterales Carriage during the COVID-19 Crisis in French Guiana

Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study

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