Isolation of Carbapenem and Colistin Resistant Gram-Negative Bacteria Colonizing Immunocompromised SARS-CoV-2 Patients Admitted to Some Libyan Hospitals

Abstract

In this work, we describe, for the first time, the occurrence of carbapenem-resistant bacteria colonizing COVID-19 patients who developed hospital-associated infections with carbapenemase-producing, Gram-negative bacteria at some isolation centers of COVID-19 in the eastern part of Libya. Our results confirmed that the overuse of antimicrobials, such as carbapenem antibiotics, during the COVID-19 pandemic has led to the emergence of multidrug-resistant bacteria, mainly K. pneumoniae and A. baumannii , as well as colistin resistance.

Clonal, Plasmidic and Genetic Diversity of Multi-Drug-Resistant Enterobacterales from Hospitalized Patients in Tripoli, Libya

“…K. pneumoniae is considered one of the major causes of global AMR burden, being among the top five most widespread nosocomial pathogens [ 24 ], and the World Health Organization (WHO) identified ESC- and carbapenem-resistant K. pneumoniae as a critical public health threat [ 25 ]. This study confirms that carbapenem-resistant K. pneumoniae are a major health issue in the Tripoli University Hospital, and most probably throughout the whole country according to the few publications on AMR in Libya [ 12 ]. Here, of the 54 isolates collected for their MDR phenotype, 49 belonged to the K. pneumoniae species, of which 35 presented at least one carbapenemase gene.…”

“…The occurrence of ESC- and carbapenem-resistant Enterobacterales, among which K. pneumoniae and, to a lesser extent, E. coli , have been evidenced by our study in Tripoli, and by Slimene et al in Sirte, Benghazi and Shahat [ 11 , 12 ], strongly suggests that these pathogens have widely disseminated in hospitals throughout Libya. Our results showed that resistance to last-resort antibiotics (ESC, carbapenems, amikacin, colistin) is conferred by a large variety of genes, plasmids and clones, thus making their transmission more efficient.…”

“…A new level of resistance was reached in 2014–2015, with the emergence of K. pneumoniae belonging to different STs (ST11, ST15, ST101, ST147, ST405) and presenting the bla OXA-48 and/or the bla NDM-1 genes in a few cases, in addition to the rmtC gene conferring resistance to amikacin, or to insertions in the mgrB conferring resistance to colistin [ 10 ]. Finally, Slimene et al reported, in 2020, 24 carbapenem-resistant Enterobacterales from a hospital in Sirte, including three K. pneumoniae OXA-48/NDM-positive ST383s and one KPC-positive ST640 [ 11 ], and in 2021, 76 carbapenem-resistant Enterobacterales from immunocompromised SARS-CoV-2 patients in Benghazi and Shahat (eastern part of Libya), which displayed various combinations of the bla OXA-48 and bla NDM genes [ 12 ].…”

Prevalence of multi-drug resistant bacteria in intensive care units at Tripoli University Hospital, Tripoli, Libya

“…Additionally, carbapenem-resistant Klebsiella pneumoniae carrying OXA-48 was detected [ 13 ]. Worryingly, carbapenem and colistin-resistant bacteria were also isolated from COVID-19 patients in Libya [ 14 ]. ESBL and MBL producing Gram-negative bacteria were isolated from operating theaters and ICU of Sabha Medical Center, Sabha city, Libya [ 15 , 16 ].…”