Summary
Background
Wards caring for COVID-19 patients, including intensive care units (ICUs), have an important focus on preventing transmission of SARS-CoV-2 to other patients and healthcare workers.
Aim
To describe an outbreak of carbapenemase-producing Enterobacterales (CPE) in a COVID-19 ICU and to discuss key infection control measures enabling prompt termination of the cluster.
Methods
CPE were isolated from clinical specimens and screening swabs from intensive care patients with COVID-19 disease and from environmental screening. Whole-genome sequencing analysis was instrumental in informing phylogenetic relationships.
Findings
Seven clinical isolates and one environmental carbapenemase-producing Klebsiella pneumoniae isolate – all carrying OXA-48, CTX-M-15 and outer membrane porin mutations in ompK35/ompK36 – were identified with ≤1 single nucleotide polymorphism difference, indicative of clonality. A bundle of infection control interventions including careful adherence with contact precautions and hand hygiene, twice weekly screening for multidrug-resistant organisms, strict antimicrobial stewardship, and enhanced cleaning protocols promptly terminated the outbreak.
Conclusion
Prolonged use of personal protective equipment is common with donning and doffing stations at the ward entrance, leaving healthcare workers prone to reduced hand hygiene practices between patients. Minimizing transmission of pathogens other than SARS-CoV-2 by careful adherence to normal contact precautions including hand hygiene, even during high patient contact manoeuvres, is critical to prevent outbreaks of multidrug-resistant organisms. Appropriate antimicrobial stewardship and screening for multidrug-resistant organisms must also be maintained throughout surge periods to prevent medium-term escalation in antimicrobial resistance rates. Whole-genome sequencing is highly informative for multidrug-resistant Enterobacterales surveillance strategies.
【저자키워드】 COVID-19, Multidrug-resistant organisms, Infection prevention and control, Carbapenemase-producing Enterobacterales, 【초록키워드】 SARS-CoV-2, infection control, Personal protective equipment, Mutation, protocol, Sequencing, intensive care unit, polymorphism, Intervention, Transmission, healthcare worker, ICU, pathogen, Surveillance, outbreak, healthcare, Patient, Cluster, disease, single nucleotide, Precaution, Critical, patients, COVID-19 patients, CPE, Prolonged, Escalation, Contact, Phylogenetic, hygiene, Klebsiella pneumoniae, Organisms, specimen, ward, measure, ICUs, organism, finding, Sequencing analysis, outer membrane, transmission of SARS-CoV-2, isolate, multidrug-resistant, Prevent, intensive care patient, reduced, Appropriate, doffing, donning, screening swab, with COVID-19, 【제목키워드】 intensive care, COVID-19 pandemic, Infection prevention, Cluster, Klebsiella pneumoniae,