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Coronavirus disease 2019 has posed a significant health care challenge globally, with intensive care unit (ICU) provision being of particular consequence [1]. In the UK, where ICU beds are already lower per head of population than in much of the rest of Europe [2], there has been a requirement to expand the ICU bed capacity rapidly in response. St George's Hospital is a 1000-bedded tertiary care hospital in South West London. From an initial ICU capacity of 60 beds spread over three purpose-built units, ICU beds expanded at peak surge in April 2020 to 83 COVID-19 beds and 13 non-COVID-19 beds (96 in total), involving additional space on two medical wards, a day unit and surgical theatres. Key differences to ICU provision during this time are summarized in Table I, and encompass changes in the environment, staffing and personal protective equipment (PPE), which combined to present a substantial infection control challenge. Patients had long average ICU stays over this period, with multiple central venous catheters (CVCs), and a high proportion of patients requiring additional access for renal replacement therapy.

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This study characterized an IncL/M-like plasmid containing a bla(OXA-48)-encoding gene from a clinical isolate of Klebsiella pneumoniae, denoted as E71T. Investigation of this plasmid sequence identified unique regions of interest along with conserved regions detected in eight other clinical carbapenem-resistant isolates. A 63-kb plasmid (pE71T) from K. pneumoniae E71T was sequenced and found to be highly similar to the recently published K. pneumoniae pOXA-48a (JN626286). Two copies of the insertion sequence element IS1R were identified, one of which was located adjacent to the bla(OXA-48)-encoding gene forming part of a composite transposon Tn1999.2 and the second located 16-kb downstream. Plasmid profiling and PCR assays confirmed that the pE71T backbone was conserved among the eight other clinical bla(OXA-48)-positive isolates, and in all cases, the OXA-48 genes were part of the Tn1999.2 composite transposon. This is the first report of a bla(OXA-48) and IS1R arrangement-containing plasmid in Ireland.