Antibiotic Consumption During the Coronavirus Disease 2019 Pandemic and Emergence of Carbapenemase-Producing Klebsiella pneumoniae Lineages Among Inpatients in a Chilean Hospital: A Time-Series Study and Phylogenomic Analysis

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dc.contributor.authorAllel, Kasim
dc.contributor.authorPeters, Anne
dc.contributor.authorConejeros, Jose
dc.contributor.authorMartinez, Jose R. W.
dc.contributor.authorSpencer-Sandino, Maria
dc.contributor.authorRiquelme-Neira, Roberto
dc.contributor.authorRivas, Lina
dc.contributor.authorRojas, Pamela
dc.contributor.authorOrellana Chea, Cristian
dc.contributor.authorGarcia, Patricia
dc.contributor.authorAraos, Rafael
dc.contributor.authorMcGovern, Olivia
dc.contributor.authorPatel, Twisha S.
dc.contributor.authorArias, Cesar A.
dc.contributor.authorLessa, Fernanda C.
dc.contributor.authorUndurraga, Eduardo A.
dc.contributor.authorMunita, Jose M.
dc.date.accessioned2025-01-20T20:08:49Z
dc.date.available2025-01-20T20:08:49Z
dc.date.issued2023
dc.description.abstractThe increased usage of carbapenems and broad-spectrum & beta;-lactams during the COVID-19 pandemic was associated with a higher prevalence of carbapenemase-producing Klebsiella pneumoniae in a public hospital in Chile. We observed emergence and spread of bla(NDM) ST45 during the pandemic.
dc.description.abstractBackground The impact of coronavirus disease 2019 (COVID-19) on antimicrobial use (AU) and resistance has not been well evaluated in South America. These data are critical to inform national policies and clinical care. Methods At a tertiary hospital in Santiago, Chile, between 2018 and 2022, subdivided into pre- (3/2018-2/2020) and post-COVID-19 onset (3/2020-2/2022), we evaluated intravenous AU and frequency of carbapenem-resistant Enterobacterales (CRE). We grouped monthly AU (defined daily doses [DDD]/1000 patient-days) into broad-spectrum & beta;-lactams, carbapenems, and colistin and used interrupted time-series analysis to compare AU during pre- and post-pandemic onset. We studied the frequency of carbapenemase-producing (CP) CRE and performed whole-genome sequencing analyses of all carbapenem-resistant (CR) Klebsiella pneumoniae (CRKpn) isolates collected during the study period. Results Compared with pre-pandemic, AU (DDD/1000 patient-days) significantly increased after the pandemic onset, from 78.1 to 142.5 (P < .001), 50.9 to 110.1 (P < .001), and 4.1 to 13.3 (P < .001) for broad-spectrum & beta;-lactams, carbapenems, and colistin, respectively. The frequency of CP-CRE increased from 12.8% pre-COVID-19 to 51.9% after pandemic onset (P < .001). The most frequent CRE species in both periods was CRKpn (79.5% and 76.5%, respectively). The expansion of CP-CRE harboring bla(NDM) was particularly noticeable, increasing from 40% (n = 4/10) before to 73.6% (n = 39/53) after pandemic onset (P < .001). Our phylogenomic analyses revealed the emergence of two distinct genomic lineages of CP-CRKpn: ST45, harboring bla(NDM), and ST1161, which carried bla(KPC). Conclusions AU and the frequency of CP-CRE increased after COVID-19 onset. The increase in CP-CRKpn was driven by the emergence of novel genomic lineages. Our observations highlight the need to strengthen infection prevention and control and antimicrobial stewardship efforts.
dc.fuente.origenWOS
dc.identifier.doi10.1093/cid/ciad151
dc.identifier.eissn1537-6591
dc.identifier.issn1058-4838
dc.identifier.urihttps://doi.org/10.1093/cid/ciad151
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/91941
dc.identifier.wosidWOS:001026057200004
dc.issue.numeroSUPP 1
dc.language.isoen
dc.pagina.finalS28
dc.pagina.inicioS20
dc.revistaClinical infectious diseases
dc.rightsacceso restringido
dc.subjectAntimicrobial resistance
dc.subjectAntibiotic consumption
dc.subjectCOVID-19
dc.subjectCarbapenemase-producing organisms
dc.subjectKlebsiella pneumoniae
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleAntibiotic Consumption During the Coronavirus Disease 2019 Pandemic and Emergence of Carbapenemase-Producing Klebsiella pneumoniae Lineages Among Inpatients in a Chilean Hospital: A Time-Series Study and Phylogenomic Analysis
dc.typeartículo
dc.volumen77
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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