Carbapenem-Resistant Klebsiella pneumoniae Infections in ICU COVID-19 Patients—A Scoping Review

Abstract

Introduction: The spread of multidrug-resistant pathogens is a serious problem and challenge for the whole medical community. Carbapenem-resistant Klebsiella Pneumoniae (CRKP) infections in immunocompromised patients have a severe course and may be fatal. Increasingly, these bacteria are exhibiting resistance to carbapenem antibiotics, which have been used as so-called drugs of last resort. The emergence of the new coronavirus and the pandemic that it has caused require changes to protect against the spread of the new SARS-CoV-2. These changes paradoxically may contribute to the spread of other infections. Methods: PubMed, Cochrane Library databases were searched using relevant keywords. A literature review of carbapenem-resistant Klebsiella Pneumoniae infection in patients hospitalized for COVID-19 was conducted according to PRISMA recommendations. A written review protocol was not prepared. Results: 1016 studies in scientific databases were searched. After rejecting duplicate studies, 964 results were obtained. Inclusion and exclusion criteria were then applied, and studies were qualitatively analyzed. Finally, 11 studies were included in the review. The results of infected patients were from six countries. The prevalence of CRKP in Covid-19 patients ranged from 0.35–53%. The majority of CRKP infected patients were male (85%), with a mean age of 61 years. Among isolates, the predominant genes were KPC, OXY-48, CTX-M, TEM, NDM and SHV. Conclusion: The results presented in our review indicate the necessity of paying attention to carbapenem-resistant Klebsiella Pneumoniae infections in patients with COVID-19. In order to prevent the increase of bacterial resistance, rational antibiotic therapy should be used, as well as continuous control and surveillance of hospital infections caused by multidrug-resistant organisms.

COVID-19 and Antimicrobial Resistance: Data from the Greek Electronic System for the Surveillance of Antimicrobial Resistance—WHONET-Greece (January 2018–March 2021)

“…Invasive infections due to multidrug resistant KPC and/or OXA-48 carbapenemase-producing K. pneumoniae have been reported by Dumitru et al [ 58 ] in nine patients hospitalized in an intensive care unit (ICU) with severe COVID-19. Another review study by Medrzycka-Dabrowska et al [ 59 ] reported COVID-19 patients with carbapenem-resistant K. pneumoniae isolates from six countries—Italy, China, Egypt, United States, Spain and Peru—at a prevalence ranging from 0.35% to 53%.…”

Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review

“…Importantly, the most frequently isolated resistance gene was KPC, followed by OXA-48 and NDM, being pneumonia and BSI the main source of infection. In contrast, urinary tract, intraabdominal, and skin and soft tissue infections were very rare, probably because the main drivers of dissemination of CR-Kp were identified to be the use of mechanical ventilation and central catheters [45].…”

Paradigm Shift in Antimicrobial Resistance Pattern of Bacterial Isolates during the COVID-19 Pandemic

“…In order to intensify the conflict, clinical evidence suggest that inadequate broad-spectrum empiric antibiotic use could be associated with higher mortality, especially in case of sepsis [ 15 ]. Such differing assumptions will eventually result in an unprecedented emergence of AMR and compromise the global efforts to combat AMR [ 16 , 17 , 18 , 19 , 20 , 21 ]. Hence, the World Health Organization (WHO) raised concerns regarding the irrational consumption of antibiotics during the COVID-19 pandemic and strictly prohibited the antibiotic prophylaxis or treatment of the patients with mild or moderate COVID-19 unless indicated [ 16 ].…”