Pan-drug resistant Providencia rettgeri contributing to a fatal case of COVID-19

Area of Science:

• Infectious Diseases
• Microbiology
• Genomics

Background:

• Prolonged hospitalization and broad-spectrum antibiotic use can lead to the emergence of multidrug-resistant organisms.
• COVID-19 patients, particularly those requiring intensive care like extracorporeal membrane oxygenation (ECMO), are vulnerable to secondary infections.

Observation:

• A strain of *Providencia rettgeri* was isolated from the bloodstream of a patient with COVID-19-related hypoxic respiratory failure on ECMO.
• This isolate demonstrated pan-resistance, including resistance to the novel antibiotic cefiderocol.

Findings:

• Whole genome sequencing revealed ten antimicrobial resistance genes in the *P. rettgeri* isolate.
• Key resistance genes identified include *bla*_NDM-1 (metallo-β-lactamase), *bla*_PER-1 (extended-spectrum β-lactamase), and the rare 16S methyltransferase gene *rmtB2*.

Implications:

• The emergence of pan-resistant Gram-negative bacteria poses a significant threat to patient care, especially in critical care settings.
• This case underscores the urgent need for novel antimicrobial strategies and enhanced infection control measures to combat resistant pathogens like *P. rettgeri*.