Summary
Objectives
In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant
Enterobacterales (NDM-CRE) in hospitalized patients has increasingly been observed
since 2018, leading in 2019 to the implementation of enhanced control measures successfully
reducing transmission. We describe the NDM-CRE epidemiology during the COVID-19 pandemic
in Tuscany.
Methods
Data on NDM-CRE patients hospitalized in five Tuscan hospitals were collected from
January 2019 to December 2021. Weekly rates of NDM-CRE cases on hospital days in medical
and critical-care wards were calculated. In March–December 2020, NDM-CRE rates were
stratified by COVID-19 diagnosis. Multi-variate regression analysis was performed
to assess outcomes' differences among two periods analysed and between COVID-19 populations.
Results
Since March 2020, an increase in NDM-CRE cases was observed, associated with COVID-19
admissions. COVID-19 patients differed significantly from non-COVID-19 ones by several
variables, including patient features (age, Charlson index) and clinical history and
outcomes (NDM-CRE infection/colonization, intensive care unit stay, length of stay,
mortality). During the pandemic, we observed a higher rate of NDM-CRE cases per hospital
day in both non-COVID-19 patients (273/100,000) and COVID-19 patients (370/100,00)
when compared with pre-pandemic period cases (187/100,00).
Conclusions
Our data suggest a resurgence in NDM-CRE spread among hospitalized patients in Tuscany
during the COVID-19 pandemic, as well as a change in patients' case-mix. The observed
increase in hospital transmission of NDM-CRE could be related to changes in infection
prevention and control procedures, aimed mainly at COVID-19 management, leading to
new challenges in hospital preparedness and crisis management planning.
Keywords
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Article info
Publication history
Published online: May 07, 2023
Accepted:
April 27,
2023
Received:
November 13,
2022
Identification
Copyright
© 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
