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Colonizations/Infections caused by carbapenem-resistant Enterobacterales are of great clinical and epidemiological importance due to their rapid dissemination and high mortality rates. In this scenario, the use of antibiotics intensified by the COVID-19 pandemic has brought about a great warning on the real impact that this pandemic could have on antimicrobial management programs and long-term antimicrobial resistance rates. The objective of this study was to evaluate the increase of New Delhi Metallo β-Lactamase (NDM)-producing Enterobacterales cases in COVID-19 units of a complex Brazilian tertiary hospital. This retrospective observational study included all patients admitted to the hospital identified as colonized or infected by NDM-producing Gram negative bacilli (GNB), from January 2017 to April 2021. Forty-two NDM-producing Enterobacterales were identified in 39 patients. The rate of NDM cases per total surveillance cultures increased progressively between 2017 and 2021 (chi-2 for trend, p < 0.0001) and was associated with a higher occurrence specifically in COVID units (Fisher exact, p < 0.0001). The molecular investigation of the NDM-producing Klebsiella pneumoniae strains revealed the emergence of diverse clones during the COVID-19 period, also with possible evidence of horizontal transmission among patients within COVID units. NDM-producing Enterobacterales with multiple and different clonalities in the COVID-19 units also raised questions about the importance of other factors besides horizontal clonal transfer, including the increase of antimicrobial consumption by these patients.

Pandoraea spp é um gênero de bactérias Gram-negativas não-fermentadoras mais comumente relatadas em portadores de fibrose cística. Relatamos neste caso paciente com infecção relacionada a dispositivo vascular tunelizado. Trata-se de paciente de 56 anos, portadora de doença renal crônica e hipertensão arterial sistêmica, sem história de doença pulmonar crônica. Necessitou início de hemodiálise (HD) 10 meses antes da internação, com inserção de cateter tunelizado. Cerca de 7 meses após, iniciou episódios de calafrios durante sessões de HD, sem outros sintomas. O cateter foi retirado, sendo inserido cateter não tunelizado. Cerca de um mês após, recorreu com calafrios durante HD, coletado culturas e iniciado terapêutica empírica com ceftazidima e vancomicina. Devido falha de resposta clínica ao esquema, paciente foi encaminhada ao hospital terciário de cardiologia. Após admissão, foi suspenso o esquema antimicrobiano e coletadas hemoculturas seriadas a fim de identificar agente etiológico. Três amostras de cultura de sangue periférico do D1 de internação e duas do D3 resultaram negativas. Três amostras de sangue do D4 resultaram positivas para Pandoraea spp (tempo de positividade em sangue de cateter de 13 horas, e em amostras de sangue periférico, de 27 horas). Posteriormente, recebida notificação de crescimento do mesmo agente em amostra coletada um dia antes da admissão em laboratório externo. Pandoraea sputorum foi identificada pela técnica de MALDI-TOF MS. Realizado perfil de sensibilidade, para o qual se mostrou resistente a amicacina e gentamicina; sensível a imipeném, piperacilina-tazobactam e ciprofloxacino. Critérios para a interpretação do perfil de sensibilidade baseados nos pontos de corte de Pseudomonas aeruginosa. A terapia guiada por cultura foi realizada com imipenem por 14 dias, associada a retirada do cateter, com remissão dos calafrios e tremores nas primeiras 48 horas. Ecocardiograma transesofágico da admissão hospitalar não evidenciou vegetações ou lesões valvulares sugestivas de endocardite. Colhidas hemoculturas periféricas de controle, as quais resultaram negativas três dias após término de antibioticoterapia. Ecocardiograma transtorácico pós tratamento sem sinais de endocardite. Por ser esse o primeiro relato na literatura de infecção da corrente sanguínea relacionada a cateter vascular por Pandoraea sputorum, chamamos atenção para a potencial emergência desse agente em pacientes submetidos a terapia de substituição renal/hemodiálise.

Background: Bathing with 2% chlorhexidine (CHG) wipes is an important measure regarding infection prevention in critically ill patients. The aim of this study was to evaluate the impact of CHG wipes bath to prevent central-line associated bloodstream infection (CLABSI) in critically ill patients and determine if such measure is cost-saving. Methods: a quasi-experimental study, conducted from July 2017 to April 2019. Daily bath with 2% CHG was used in all patients at the unit in the intervention period. The following were evaluated: CLABSI incidence density in both periods, 30- day mortality, guided antimicrobials used to treat CLABSI and 2% CHG costs. Results: CLABSI incidence density dropped from 8.69 to 1.83 per 1.000 central line-days (p = 0.001), mainly by Klebsiella pneumoniae Carbapenen Resistant (Kp-KPC) (p = 0.05). Costs with guided antimicrobials for the treatment in pre-intervention were US$ 46,114.36, and in the intervention period, US$ 4,177.50. The 2% CHG monthly cost was US$ 2,698.00, achieving 30% savings when comparing both periods. Discussion: An expressive reduction of 79% in CLABSI incidence density was observed, mainly due to Kp-KPC infection and also a reduction in guided antimicrobial costs. Conclusions: Bathing with 2% CHG led to evident CLABSI reduction.

At our institution, we observed an increase in the incidence of healthcare-associated infections (HAI) due to Gram-negative bacilli, including three cases of carbapenem-resistant Klebsiella pneumoniae, among patients who underwent renal transplantation. In addition to strengthening infection control measures, we chose to add gentamycin to the antibiotic prophylaxis regimen of patients undergoing renal transplantation. We assessed the number of HAI occurring within 30 days of renal transplantation during two time periods: (1) the preintervention period, between September 2009 and June 2010, and (2) the post-intervention period, between July 2010 and April 2011. The intervention consisted of the addition of gentamycin to the surgical antibiotic prophylaxis regimen. The percentage of patients with HAIs was 31% lower during the post-intervention period (p = 0.03), with the greatest reductions observed for urinary tract infections (p = 0.024). Carbapenem-resistant K. pneumoniae was not isolated during this period. The investigated patients did not exhibit worsening renal function. Further studies are needed to assess antibiotic prophylaxis in renal transplantation patients at institutions where there is a high prevalence of multidrug-resistant Gram-negative bacteria.