Carbapenemase-producing Enterobacterales infections in COVID-19 patients

Abstract

Background

Carbapenemase-producing Enterobacterales (CPE) infections have been occasionally described in patients with coronavirus disease-19 (COVID-19). We assess the clinical features and outcome of these infections.

Methods

In this retrospective single-centre, case-control study, we included 54 patients with CPE infection: 30 case-patients (COVID-19) and 24 controls (non-COVID-19), collected between March and May 2020. We compared the epidemiological, clinical features, and outcome between cases and controls.

Results

CPE infection was more frequent in COVID-19 patients than in controls (1.1 vs. 0.5%, p = .005). COVID-19 patients were younger, had a lower frequency of underlying diseases (p = .01), and a lower median Charlson score (p = .002). Predisposing factors such as antimicrobial use, mechanical ventilation, or ICU admission, were more frequent in COVID-19 patients (p < .05). There were 73 episodes of infection (42 cases and 31 controls) that were more frequently hospital-acquired and diagnosed at the ICU in COVID-19 patients (p < .001). Urinary tract was the most common source of infection (47.9%), followed by pneumonia (23.3%). The frequency of severe sepsis or shock (p = .01) as well as the median SOFA score (p = .04) was higher in cases than in controls. Klebsiella pneumoniae (80.8%), Serratia marcescens (11%) and Enterobacter cloacae (4.1%) were the most common bacteria in both groups (KPC 56.2%, OXA-48 26% and VIM 17.8%). Overall 30-d mortality rate of COVID-19 patients and controls was 30 and 16.7%, respectively (p = .25).

Conclusions

COVID-19 patients have an increased risk of CPE infections, which usually present as severe, nosocomial infections, appearing in critically-ill patients and associated with a high mortality.

Keywords:

• COVID-19
• SARS-CoV-2
• carbapenemase-producing Enterobacterales
• multidrug-resistant
• outcome

Acknowledgements

The authors acknowledge Professor Santiago Moreno (Infectious Diseases Department, Hospital Ramón y Cajal, Madrid) for his constant and inspiring support of clinical research, and especially to the Infectious Diseases Team that has taken great care of these patients during these months.

Ethics approval

The study was approved by the Ethics Committee of the Hospital Ramón y Cajal (Madrid, Spain). Informed consent was waived because no intervention was involved and no identifying patient information was included. The study complies with the principles of the 1964 Helsinki Declaration and its later amendments.

Disclosure statement

The authors declare that they have no conflict of interest.

Author contributions

All the authors participated sufficiently in the conception, analysis of the data, design and writing of the manuscript and take public responsibility for it. All the authors believe that the manuscript represents valid work and all have reviewed and approved the final version for publication.

Additional information

Funding

The research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.