key: cord-0915892-p6x755kp
authors: Arcari, Gabriele; Raponi, Giammarco; Sacco, Federica; Bibbolino, Giulia; Lella, Federica Maria Di; Alessandri, Francesco; Coletti, Monica; Trancassini, Maria; Deales, Alberto; Pugliese, Francesco; Antonelli, Guido; Carattoli, Alessandra
title: Klebsiella pneumoniae infections in COVID-19 patients: a two-month retrospective analysis in an Italian hospital
date: 2020-11-27
journal: Int J Antimicrob Agents
DOI: 10.1016/j.ijantimicag.2020.106245
sha: e4d3b4f2c5e70bce00b1ed2e5fdd48e9cf6019ba
doc_id: 915892
cord_uid: p6x755kp

nan

Italy has experienced one of the harshest and earliest COVID-19 epidemics, with the number of patients infected that followed, from the end of February up to the end of March, an exponential trend [1] . Between the 6 March and the 2 May, 394 patients were confirmed positive for SARS-CoV-2 at the University Hospital of Rome Policlinico Umberto I (PUI) [2] . At the PUI, 5 COVID-19 devoted wards were organized, including two brand new ICUs, counting 32 dedicated to COVID-19 patients: the first was the old general ICU converted into a dedicated COVID-19 ICU, while the second was created in the spaces of four operating rooms (new ICU).

In the period of this study, a total of 80 COVID-19-affected patients were hospitalized in the two ICUs at PUI.

Among them, 65 patients were screened for carbapenemase producing Enterobacterales (CPE) colonization (Table 1) . Symptomatic patients were successfully treated with ceftazidime-avibactam.

By preliminary PCR-testing (GeneXpert, Cepheid, Sunnyvale, California, USA), 10/14 K. pneumoniae strains (71%) from the COVID-19 patients were positive for the bla OXA-48 gene (5 from bronchoalveolar lavage, 1 from blood culture and 4 from rectal swab) and 4 (29%) for bla KPC (1 from blood culture and 3 from rectal swab). Figure 1) . These data indicated the contemporary circulation of two independent clones in the same COVID-19 ICU. Both clones belonged to the high-risk sequence type ST101 [3] but were substantially different. The OXA-48-producers have been rarely reported in Italy, while the KPC-producers are endemic in our country (http://atlas.ecdc.europa.eu/public/index.aspx).

This study aims to supply a starting point of reflection about the great risk of CPEs colonization and HAI in COVID-19 ICUs.

During the first months of the COVID-19 pandemic, antimicrobial stewardship programs have been put to the test; even though a higher attention on hand hygiene and the attempts to limit patient contact could have led to a reduction in the transmission of the HAIs, at the same time other risky behaviours took place.

Giving the priority of isolation chambers to quarantine COVID-19 affected patients and gathering them together in devoted wards or ICUs without the chance to contain patients colonized with CPEs, may have led to introduction of colonized patients into the ICU, followed by potential propagation and hospital transmission of the entered CPEs [4] . Gloves and gowns, which were rare goods at that time, have been primarily delivered and, in that emergency situation, utilized more for personal protection of the healthcare workers from COVID-19 than as tools to protect patients from HAIs. In parallel, the potential propagation of CPEs may also be worsened by an increased rate of antimicrobial prescriptions in the absence of clear guidelines [5] . 

Facing Covid-19 in Italy -Ethics, Logistics, and Therapeutics on the Epidemic's Front Line

SARS-CoV-2 diagnostics in the virology laboratory of a University Hospital in Rome during the lockdown period

Diversity, virulence, and antimicrobial resistance in isolates from the newly emerging klebsiella pneumoniaeST101 Lineage

COVID-19: don't neglect antimicrobial stewardship principles!

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study