Increased Risk of Acquisition of New Delhi Metallo-Beta-Lactamase-Producing Carbapenem-Resistant Enterobacterales (NDM-CRE) among a Cohort of COVID-19 Patients in a Teaching Hospital in Tuscany, Italy

Abstract

We describe the epidemiology of New Delhi Metallo-Beta-Lactamase-Producing Carbapenem-Resistant Enterobacterales (NDM-CRE) colonization/infection in a cohort of COVID-19 patients in an Italian teaching hospital. These patients had an increased risk of NDM-CRE acquisition versus the usual patients (75.9 vs. 25.3 cases/10,000 patient days). The co-infection significantly increased the duration of hospital stay (32.9 vs. 15.8 days).

Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions — New Jersey, February–July 2020

“…In response to a rapid increase in SARS-CoV-2 infections, many health care facilities adopted mitigation strategies to contend with physical space limitations, constrained availability of personnel, shortages in PPE, and a large number of critically ill patients. Recent single-facility reports from the United States and Europe have described increased acquisition of MDROs among patients hospitalized with COVID-19 ( 6 – 8 ). Hospital A experienced a large multidrug-resistant CRAB outbreak, primarily involving ICU patients, which extended across multiple units during a surge in COVID-19 cases.…”

“…from specimens collected in February and March harbored an additional carbapenemase gene, encoding New Delhi metallo-β-lactamase (a gene rarely present in CRAB isolates from patients in the United States), indicating that at least one CRAB introduction occurred before the surge of COVID-19 cases(5). Four specimens were nonviable or did not yield CRAB growth.During March-August 2020, hospital A admitted approximately 850 patients with COVID-19.…”

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

“…While experts have warned of the link between COVID-19 and AMR [3][4][5][6][7][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][10][11][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.…”

The Complexity of Co-Infections in the Era of COVID-19

“…The lower incidence is most common among the very early phases of infection as would be anticipated [ 76 , 134 ]. The type of proposed co-pathogen changes during the course of COVID-19 [ 49 , 76 , 118 , 128 , 134 – 140 ]. Common respiratory bacteria more often cause infection in early stages of the illness [ 75 , 125 , 129 , 133 , 141 – 143 ].…”