Trends in carbapenem resistance in Pre-COVID and COVID times in a tertiary care hospital in North India

Abstract

Background Carbapenem resistance is endemic in the Indian sub-continent. In this study, carbapenem resistance rates and the prevalence of different carbapenemases were determined in Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa during two periods; Pre-COVID (August to October 2019) and COVID (January to February 2021) in a north-Indian tertiary care hospital. Methods Details of patient demographics and clinical condition was collated from the Hospital Information System and detection of carbapenemases NDM, OXA-48, VIM, IMP and KPC was done by Polymerase chain reaction (PCR) in 152 and 138 non-consecutive carbapenem resistant isolates during the two study periods respectively. Conjugation assay and sequencing of NDM and OXA-48 gene was done on a few selected isolates. Results As compared to Pre-COVID period, co-morbidities and the mortality rates were higher in patients harbouring carbapenem resistant organisms during the COVID period. The overall carbapenem resistance rate for all the four organisms increased from 23 to 41% between the two periods of study; with Pseudomonas aeruginosa and Klebsiella pneumoniae showing significant increase (p < 0.05). OXA-48, NDM and co-expression of NDM and OXA-48 were the most common genotypes detected. NDM-5 and OXA-232 were most common variants of NDM and OXA-48 family respectively during both the study periods. Conclusion Higher rate of carbapenem resistance in COVID times could be attributed to increase in number of patients with co-morbidities. However, genetic elements of carbapenem resistance largely remained the same in the two time periods.

Frequency Of Bacterial Co-Infections Isolated from Covid-19 Positive Patients From Tertiary Care Hospital Of Karachi

“…The present study found a significant prevalence of carbapenem-resistant K. pneumoniae in the sputum of Covid-19 positive patients, followed by MRSA (methicillin-resistant S. aureus), which is consistent with the findings of a review study by Wioletta et al 26 . The high occurrence of K. pneumoniae NDM is likely due to the complex respiratory pathology associated with Covid-19 infection, mechanical intubation, exposure to carbapenems and β-lactam/β-lactamase inhibitors, blood transfusions, and prolonged hospital stay 27,28 . The current study suggests that SARS-CoV-2 infection may have a detrimental effect on the immune system of patients, and the exact mechanism by which natural killer cells and antibodies are triggered remains unclear.…”

Emerging Antibiotic Resistance in Post-COVID-19 Co-infections

“…A tertiary care hospital in North India compared the carbapenem resistance rates from August-October 2019 with those in early 2021. Overall carbapenem resistance increased from 23% (pre-COVID) to 41% (COVID period) in Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa [32].…”

“…Many similar studies reported that COVID-19 patients received antibiotics at admission; while the reported rate of bacterial infections was lower [27][28][29][30][31]. Another retrospective observational study reported an outbreak of A. baumannii in COVID-19 patients and identified carbapenem-resistant strains [32].…”

“…Carbapenems are a class of antibiotics that are often used as a last resort for treating serious bacterial infections, but some strains of bacteria have developed resistance to these drugs. The most reported carbapenem-resistant bacteria are Klebsiella pneumoniae and Acinetobacter baumannii, which can cause infections in healthcare settings [32]. A tertiary care hospital in North India compared the carbapenem resistance rates from August-October 2019 with those in early 2021.…”

“…A study published in the Journal of Global Antimicrobial Resistance in June 2021 evaluated the susceptibility patterns of bacteria isolated from patients with COVID-19 in a hospital in India. The study found that the most common bacterial pathogens were Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii and that they showed high levels of resistance to several antibiotics, including carbapenems, 3 rd generation cephalosporins, and fluoroquinolones [32,51]. The study highlights the importance of antibiotic stewardship programs to prevent the emergence of antibiotic resistance.…”