Nosocomial Outbreak of Extensively Drug-Resistant (Polymyxin B and Carbapenem) Klebsiella pneumoniae in a Collapsed University Hospital Due to COVID-19 Pandemic

Abstract

We correlated clinical, epidemiological, microbiological, and genomic data of an outbreak with polymyxin B (PB)- and carbapenem-resistant Klebsiella pneumoniae during the COVID-19 pandemic. Twenty-six PB- and carbapenem-resistant K. pneumoniae were isolated from patients in the COVID-19 ICU (Intensive Care Unit), non-COVID-19 ICU (Intensive Care Unit), clinical, or surgical ward. Bacterial identification, drug susceptibility tests, and DNA sequencing were performed, followed by in silico resistance genes identification. All isolates showed extensively drug-resistant (XDR) phenotypes. Four different sequence types (ST) were detected: ST16, ST11, ST258, and ST437. Nineteen isolates were responsible for an outbreak in the ICU in September 2020. They belong to ST258 and harbored the 42Kb IncX3plasmid (pKP98M3N42) with the same genomic pattern of two K. pneumoniae identified in 2018. Twenty-four isolates carried bla-KPC-2 gene. No plasmid-mediated colistin (mcr) resistance genes were found. Eight isolates presented mgrB gene mutation. The clonal isolates responsible for the outbreak came from patients submitted to pronation, with high mortality rates in one month. XDR-K. pneumoniae detected during the outbreak presented chromosomal resistance to PB and plasmid-acquired carbapenem resistance due to KPC production in most isolates and 42Kb IncX3(pKP98M3N42) plasmid carrying blaKPC-2 was associated with ST258 isolates. The outbreak followed the collapse of the local healthcare system with high mortality rates.

A large multicenter Ralstonia pickettii outbreak in critically ill patients during the COVID-19 pandemic: Epidemiological and clinical characteristics of 66 cases

“…Studies suggest that during the coronavirus disease 2019 (COVID-19) pandemic, there was an increase in the incidence of nosocomial outbreaks (Gaspar et al, 2022). Disruption of infection prevention and control practices during the pandemic, including shortages of personal protective equipment and overloading of healthcare workers, might have contributed to the increased incidence of outbreaks (Comelli et al, 2022; Gaspar et al, 2022). Similarly, in some regions, there has been an increase in the incidence of infections caused by multidrug-resistant (MDR) bacteria during the pandemic (Abubakar et al, 2023).…”

Metagenomic insights for antimicrobial resistance surveillance in soils with different land uses in Brazil

“…Previous studies have shown the seriousness and urgent need to tackle AMR in the countryside of São Paulo, Brazil, especially after COVID-19 pandemic [17]. During this period, high rates of antibiotic use in hospitalized patients and prolonged time in invasive therapy have caused an alarming increase in polymyxin B-resistant Klebsiella pneumoniae isolates in 2021 [18] and a nosocomial outbreak of extensively drug-resistant (EDR) K. pneumoniae in 2022 [19].…”