Nosocomial infections by diverse carbapenemase-producing Aeromonas hydrophila associated with combination of plumbing issues and heat waves.

BACKGROUND: Aquatic opportunistic pathogen Aeromonas hydrophila, known to persist in low-nutrient chlorinated waters, can cause life-threatening infections. Two intensive care units experienced a cluster of Aeromonas infections following outdoor temperature spikes coinciding with recurrent plumbing issues, with fatalities due to severe underlying comorbidities co-occurring with extensively-drug resistant (XDR) Aeromonas. METHODS: We investigated this cluster using whole genome sequencing to assess genetic relatedness of isolates and identify antimicrobial resistance determinants. Three A. hydrophila were isolated from patients staying in or adjacent to rooms with plumbing issues during or immediately after periods of elevated outdoor temperatures. Sinks and faucets were swabbed for culture. RESULTS: All A. hydrophila clinical isolates exhibited carbapenem resistance but were not genetically related. Diverse resistance determinants corresponding to extensively-drug resistant were found, including co-occurring KPC-3 and VIM-2, OXA-232, and chromosomal CphA-like carbapenemase genes, contributing to major treatment challenges. All 3 patients were treated with multiple antibiotic regimens to overcome various carbapenemase classes and expired due to underlying comorbidities. Environmental culture yielded no Aeromonas. CONCLUSIONS: While the investigation revealed no singular source of contamination, it supports a possible link between plumbing issues, elevated outdoor temperatures and incidence of nosocomial Aeromonas infections. The diversity of carbapenemase genes detected in these wastewater-derived Aeromonas warrants heightened infection prevention precautions during periods of plumbing problems especially with heat waves.

Case Report: Challenges of Diagnosing Malaria in Returning Travelers at the Height of COVID-19 Pandemic.

In 2021, we treated three patients in Southern California who contracted malaria while traveling in Uganda. Two patients visited the Nile River in Uganda in the months of July and August 2021, and upon returning to the United States, diagnosis was delayed due to limited access to care during the COVID-19 pandemic. One of the patients developed severe malaria, and the second developed parasitemia after he stopped taking malaria prophylaxis. The third patient, who traveled to Kampala, Uganda, in December 2021 returned home and was admitted for chronic medical conditions. Later in the clinical course, he developed symptoms consistent with malaria, but due to SARS-CoV-2 diagnosis, there was no suspicion of malaria infection until it was incidentally discovered while performing a blood manual differential. All patients were treated for malaria and recovered uneventfully.

Disguised as Ovarian Tumor: A Rare Case of Uterine Abscess Due to Hypervirulent Klebsiella pneumoniae Infection.

Hypervirulent Klebsiella pneumoniae (hvKp) causes invasive infections in the community setting. We report a rare case of uterine abscess due to hvKp, which appeared as a large-sized ovarian tumor-like pelvic mass. A timely laboratory warning of possible hvKp prompted correct diagnosis and helped guide perioperative decision making, contributing to successful treatment.