Scientists have studied how the multi-resistant bacterium Klebsiella pneumoniae has evolved in hospital Intensive Care Units (ICUs) during the COVID-19 pandemic.
A team from the Carlos III Health Institute (ISCIII), collaborating for the Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC) of Spain, at the Spanish National Center for Microbiology, has studied how the pandemic and the high occupancy of the units intensive care units (ICU) have modified the presence of multiresistant bacteria.
The results specifically highlight a probable change in the population of the Klebsiella pneumoniae bacterium, responsible for infections, pneumonia and sepsis, and to which ICU patients are especially vulnerable.
Infections by multi-resistant bacteria are an important public health problem, which is more relevant in ICUs. Jesús Oteo, director of CIBERINFEC and researcher at the ISCIII National Center for Microbiology, explains the basis of the research: “We have studied the interaction of two of the main health threats in the field of infectious diseases: infection by SARS-CoV2 and the multiresistant bacterium K. pneumoniae that produces carbapenemases, which are enzymes capable of destroying many of the antibiotics used for this and other bacteria”.
The study has compared the presence of this bacterium (Kpn-PC) before and during the pandemic, observing the emergence of new clones of K. pneumoniae that produce a carbapenemase (VIM-1) that was not previously among the most frequent. The team also observed the association of this VIM-1 enzyme in these clones with the same plasmid, an element that allows the transmission of resistance genes between bacteria: “Very similar plasmids have previously been responsible for a large worldwide spread of another type of carbapenemases”, warns Oteo.
Jesús Oteo, in the center, together with his CIBERINFEC research team at the ISCIII National Center for Microbiology. (Photo: CIBERISCIII / CIBERINFEC)
During the COVID-19 pandemic, the number of ICU patients coinfected by microorganisms in the hospital environment has increased. In this work, the researchers have tried to determine the degree to which the pandemic could have influenced the status of these microorganisms: “Strategies to manage patients with COVID-19 should include approaches to mitigate the impact of multi-resistant bacterial infections ”, recalls the CNM and CIBERINFEC researcher.
According to Oteo, “CP-Kpn populations from the pandemic and pre-pandemic periods have similarities, however, isolates displaying VIM-1 associated with atypical sequenciotypes appear to have increased during the pandemic, requiring additional monitoring and surveillance.” .
The team characterized the types of multiresistant K. pneumoniae isolates in 84 COVID-19 patients from the ICUs and compared the epidemiology and microbiological characteristics of these isolates with those obtained in 74 patients before the start of the pandemic (40 ICUs and 34 non-ICUs). ICUs) in different Spanish hospitals.
The study has made it possible to identify the populations and the resistance mechanisms of the isolates by sequencing the complete genome, analyzing the phylogeny, the reconstruction of plasmids and carrying out antibiotic susceptibility tests: “The antibiotics that obtained greater sensitivity against the pandemic and prepandemic isolates were cefiderocol and plazomicin; the 307 sequence was the most frequent in both groups, but VIM-1 type carbapenemase-producing CP-Kpn were detected in infrequent sequences during the COVID-19 period,” adds Oteo.
Carbapenem antibiotics are among the latest therapeutic drugs available to eradicate these infections. In addition, the isolates by this CP-Kpn bacterium frequently demonstrate a greater capacity for persistence, rapid dispersal, and emergence, which has implications for colonization, propagation of clones of the microorganisms in the high-risk hospital environment, and co-resistance to antibiotics. no carbapenems.
“Modifications in the use of antibiotics in general, and in particular against infections produced by CP-Kpn, may contribute to the selection of different types of carbapenemases and clones prone to carrying them. Both the pandemic and the commercialization of new antibiotics against this type of bacteria could have been factors that contributed to changing the use of antibiotics in ICUs”, concludes the ISCIII researcher.
According to the team, up-to-date knowledge on resistant bacteria will allow early detection of emerging resistance mechanisms and the clones or mobile genetic elements that carry them and facilitate their propagation. They also point to the need for continuous monitoring of the appearance of new clones of this bacterium.
In addition to the team from the National Center for Microbiology of the ISCIII and CIBERINFEC, professionals from the Respiratory Diseases area of CIBER (CIBERES), also dependent on the ISCIII, and from the Microbiology services of various hospitals in Madrid have participated in this work: Hospital Universitario October 12, Infanta Sofía Hospital, HM Hospitals, San Carlos Clinical Hospital and Gregorio Marañón General University Hospital.
The study is titled “Carbapenemase-Producing Klebsiella pneumoniae in COVID-19 Intensive Care Patients: Identification of IncL-VIM-1 Plasmid in Previously Non-Predominant Sequence Types. And it has been published in the academic journal Antibiotics. (Source: CIBERISCIII / CIBERINFEC)