By NewsDesk @bactiman63
The Pan American Health Organization (PAHO) reports during the COVID-19 pandemic, the emergence of extensively antimicrobial-resistant microorganisms and an increase in the incidence of resistance to carbapenems, possibly related to the increased use of broad-spectrum antibiotics in patients with COVID-19, has been documented.
At the same time, an increase in the rate of device-associated healthcare-associated infections has been observed in intensive care units (ICUs), mainly due to central vascular catheter and mechanical ventilation.
The Latin American Antimicrobial Resistance Surveillance Network (ReLAVRA as per its acronym in Spanish) has been monitoring resistance to carbapenems in gram-negative bacilli for more than 15 years. Between 2006 and 2010, resistance to carbapenems in K. pneumoniae was detected sporadically in some countries. Between 2010 and 2019, the countries within this network reported a slow but sustained increase in resistance, with a wide heterogeneity in magnitude and reaching a prevalence greater than 60% in some countries. This high prevalence must be interpreted with caution, as there could be some bias in the selection of strains for surveillance.
Since the beginning of the pandemic, the national authorities of several countries in the Region, based on the results of the national reference laboratories that are members of ReLAVRA, have issued alerts on the emergence of carbapenemase-producing Enterobacterales (CPE) not previously described, or an increasing number of isolates that co-express two or more of these enzymes. A selection of these is listed below:
- Argentina describes in its alert that during the period May to November 2020, the coproduction of KPC and NDM was identified as the most prevalent combination of carbapenemases (16%) among the carbapenem-resistant Enterobacteriaceae (CRE) received in the national reference laboratory. This combination had not been previously documented in the country.
- In Uruguay, an increase in isolates producing KPC and NDM was observed, from 1% during 2017-2019 to 3.3% between January 2020 and May 2021.
- In Ecuador, alerts were issued regarding the first co-producing isolates of KPC and NDM (K. pneumoniae) and of KPC and OXA-48 (Escherichia coli) in early 2021.
- In Guatemala, an alert was issued regarding the detection of the first isolates belonging to the Enterobacter cloacae complex producing KPC and NDM in July 2021.
- In Paraguay, in July 2021, the first isolates co-producing the carbapenemases KPC and NDM were reported in two isolates of K. pneumoniae.
Additionally, the emergence of carbapenemases that had not previously been detected at the national level was reported: the first isolates of NDM-producing Enterobacterales were identified in Belize,
and the first isolates of the OXA-48 carbapenemase were identified in Chile and in Guatemala.