Persistent Urinary Tract Infection in Association with Community- Acquired NDM-5 Escherichia coli Clonal Group Following COVID-19 Infection-Beijing Municipality, China, 2023

What is already known about this topic?The hospital-acquired infections caused by New Delhi metallo-beta-lactamase (NDM)-producing strains are typically attributed to a single clonal lineage.What is added by this report?In this study, we encountered a unique case of community-acquired NDM-5 Escherichia coli urinary tract infection (UTI) following coronavirus disease 2019 (COVID-19). The UTI persisted for a duration of at least 45 days. Genomic analyses revealed the presence of two NDM-5 strains, both sharing an identical chromosomal background but distinct, homologous, and recombined plasmids. This case suggests that a diverse range of resistance genes may be present within the human body, with drug-resistant strains undergoing continuous evolution during infection. The intestinal tract may have been its drug -resistant gene pool. What are the implications for public health practice? The observations presented in this case indicate that the endogenous acquisition of drug-resistant genes may also be an issue in managing multidrug-resistant organisms (MDRO). It is possible for continuous recombination to occur within carbapenem-resistant Enterobacteriaceae (CRE) during infection. In contrast to exogenously-acquired resistance, greater attention should be placed on the endogenous factors that contribute to the development of CRE within healthcare settings.

Automated summary

This study reports a unique case of community-acquired NDM-5 Escherichia coli urinary tract infection (UTI) following COVID-19. The UTI persisted for at least 45 days. Genomic analyses revealed the presence of two NDM-5 strains, with identical chromosomal background but distinct plasmids. This case suggests the presence of diverse resistance genes in the human body, and the continuous evolution of drug-resistant strains during infection, possibly originating from the intestinal tract.