Gram-negative ESKAPE bacteria bloodstream infections in patients during the COVID-19 pandemic

Bloodstream infections due to bacteria are a highly consequential nosocomial occurrences and the organisms responsible for them are usually multidrug-resistant. The aims of this study were to describe the incidence of bacteremia caused by Gram-negative ESKAPE bacilli during the COVID-19 pandemic and characterize the clinical and microbiological findings including antimicrobial resistance. A total of 115 Gram-negative ESKAPE isolates were collected from patients with nosocomial bacteremia (18% of the total bacteremias) in a tertiary care center in Mexico City from February 2020 to January 2021. These isolates were more frequently derived from the Respiratory Diseases Ward (27), followed by the Neurosurgery (12), Intensive Care Unit (11), Internal Medicine (11), and Infectious Diseases Unit (7). The most frequently isolated bacteria were (34%), followed by (28%), (23%) and spp (16%). showed the highest levels of multidrug-resistance (100%), followed by (87%), spp (34%) and (20%). The and genes were identified in all beta-lactam-resistant (27), while was found in 84.6% (33/39) of isolates. The carbapenemase gene was predominant among carbapenem-resistant (74%, 29/39) and was detected in four isolates. One isolate was gene carrier, while two and one spp were gene carriers. Among colistin-resistant isolates gene was not detected. Clonal diversity was observed in , and spp. Two outbreaks caused by ST208 and ST369 were detected, both belonging to the clonal complex CC92 and IC2. was associated with a death rate of 72% (28/32), most of them (86%, 24/28) extensively drug-resistant or pandrug-resistant isolates, mainly in patients with COVID-19 (86%, 24/28) in the Respiratory Diseases Ward. isolates had a higher mortality rate (72%), which was higher in patients with COVID-19. There was no statistically significant association between the multidrug-resistant profile in Gram-negative ESKAPE bacilli and COVID-19 disease. The results point to the important role of multidrug-resistant Gram-negative ESKAPE bacteria causing bacteremia in nosocomial settings before and during the COVID-19 epidemic. Additionally, we were unable to identify a local impact of the COVID-19 pandemic on antimicrobial resistance rates, at least in the short term.