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Introduction: A decrease of detection of outbreaks by multidrug-resistant bacteria in critical areas has been reduced due to COVID-19 pandemic. Therefore, molecular epidemiological surveillance should be a primary tool to reveal associations not evident by classical epidemiology. The aim of this work was to demonstrate the presence of hidden outbreaks in the first wave of the COVID-19 pandemic and to associate their possible origin., Methods: A population of 96 COVID-19 patients was included in the study (April to June 2020) from Hospital Juárez de México. Genetic identification and antimicrobial susceptibility testing of VAP causative agents isolated from COVID-19 patients was performed. Resistance phenotypes were confirmed by PCR. Clonal association of isolates was performed by analysis of intergenic regions obtained. Finally, the association of clonal cases of VAP patients was performed by timelines., Results: ESKAPE and non-ESKAPE bacteria were identified as causative agents of VAP. ESKAPE bacteria were classified as MDR and XDR. Only A. baumannii and P. aeruginosa were identified as clonally distributed in 13 COVID-19/VAP patients. Time analysis showed that cross-transmission existed between patients and care areas., Conclusions: Acinetobacter baumannii and Pseudomonas aeruginosa were involved in outbreaks non-detected in COVID-19/VAP patients in the first wave of COVID-19 pandemic., (Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background . The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a predisposing factor for the development of healthcare-associated infections, of which ventilator-associated pneumonia (VAP) is one. Hypothesis . VAP is caused by ESKAPE bacteria and other pathogens not detected by microbiological culture. Aim . To elucidate the bacterial pathogens of severe coronavirus disease 2019 (COVID-19) and VAP patients by massive sequencing and to predict their degree of relationship with the age and sex of the patients. Methods . Analysis of ribosomal libraries of the V3-V4 hypervariable region obtained by Illumina sequencing of bronchoalveolar lavages from COVID-19 and VAP (first wave) patients from Hospital Juárez de México. Results . Acinetobacter and Pseudomonas were the main bacterial genera in the bronchoalveolar lavages (BALs) analysed. Other members of the ESKAPE group, such as Enterococcus and Klebsiella , were also identified. Taxonomic composition per patient showed that non-ESKAPE genera were present with significant relative abundances, such as Prevotella , Stenotrophomas , Enterococcus , Mycoplasma , Serratia and Corynebacterium . Kruskal-Wallis analysis proved that VAP acquisition is an adverse event that is not influenced by the sex and age of COVID-19 patients. Discussion . Metagenomic findings in COVID-19/VAP patients highlight the importance of implementing comprehensive microbiological diagnostics by including alternative tools for the detection of the causal agents of healthcare-associated infections (HAIs). Conclusions . Timely identification of bacteria 'not sought' in diagnostic bacteriology laboratories will allow specific and targeted treatments. Implications for the restricted diagnosis of VAP causative agents in COVID-19 patients and the presence of pathogens not detected by classical microbiology are analysed and discussed.

Background: Mechanical ventilators are essential biomedical devices for the respiratory support of patients with SARS-CoV-2 infection. These devices can be transmitters of bacterial pathogens. Therefore, it is necessary to implement effective disinfection procedures. The aim of this work was to show the impact of the modification of a cleaning and disinfection method of mechanical ventilators of patients with SARS-CoV-2 and ventilator-associated pneumonia., Methods: A total of 338 mechanical ventilators of patients infected with SARS-CoV-2 and ESKAPE bacteria were divided in two groups. Group A and B were subjected to cleaning and disinfection with superoxidation solution-Cl/enzymatic detergent and isopropyl alcohol, respectively. Both groups were cultured for the detection of ESKAPE bacteria. The isolates were subjected to tests for identification, resistance, adherence, and genomic typing., Results: Contamination rates of 21.6% (n = 36) were identified in group A. The inspiratory limb was the circuit involved in most cases of postdisinfection contamination. Acinetobacter baumanni, Pseudomonas aeruginosa, and multi-resistant Klebsiella pneumoniae were the pathogens involved in the contamination cases. The pathogens were highly adherent and in the case of A. baumanni, clonal dispersion was detected in 14 ventilators. Disinfection with enzymatic detergents allows a 100% reduction in contamination rates., Conclusions: The implementation of cleaning and disinfection with enzymatic detergents/isopropyl alcohol of mechanical ventilators of patients with SARS-CoV-2 and ESKAPE bacteria had a positive impact on postdisinfection microbial contamination rates., Competing Interests: Declaration of competing interest All authors report no conflicts of interest relevant to this article., (Copyright © 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: SARS-CoV2 pandemic marks the need to pay attention to bacterial pathogens that can complicate the hospital stay of patients in the intensive care unit (ICU). ESKAPE bacteria which includes Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter cloacae are considered the most important, because of their close relationship with the development of ventilator-associated pneumonia (VAP). The aim of this work was to identify and characterize ESKAPE bacteria and to detect their possible clonal spread in medical devices, patients, and medical personnel of the ICU for COVID-19 patients of the Hospital Juarez de Mexico., Methodology: Genetic identification of ESKAPE bacteria was performed by analyzing the 16S rRNA gene. Resistance assays were performed according to the CLSI guidelines. Assembly of AdeABCRS operon and inhibition assays of pumps efflux in Acinetobacter baumannii isolates were performed. Associated gene involved in biofilm formation (icaA) was performed in isolates belonging to the Staphylococcus genus. Finally, typing by ERIC-PCR and characterization of mobile genetic element SCCmec were done., Results: Heterogeneous distribution of ESKAPE and non-ESKAPE bacteria was detected in various medical devices, patients, and medical personnel. Acinetobacter baumannii and Staphylococcus aureus were the predominant ESKAPE members. The analysis of intergenic regions revealed an important clonal distribution of A. baumannii (AdeABCRS+). Genotyping of SCCmec mobile genetic elements and the icaA gene showed that there is no clonal distribution of S. aureus., Conclusions: Clonal spread of A. baumannii (AdeABCRS+) highlights the importance of adopting good practices for equipment disinfection, surfaces and management of COVID-19 patients., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2021 Emilio Mariano Duran-Manuel, Clemente Cruz-Cruz, Gabriela Ibanez-Cervantes, Juan Carlos Bravata-Alcantara, Oscar Sosa-Hernandez, Laura Delgado-Balbuena, Gregorio Leon-Garcia, Iliana Alejandra Cortes-Ortiz, Monica Alethia Cureno-Diaz, Graciela Castro-Escarpulli, Juan Manuel Velez-Resendiz, Juan Manuel Bello-Lopez.)