A large multicenter Ralstonia pickettii outbreak in critically ill patients during the COVID-19 pandemic: Epidemiological and clinical characteristics of 66 cases

Objective

To describe a multicenter outbreak of R. pickettii that occurred in a large number of critically ill patients in a city in Colombia, during the COVID-19 pandemic.

Methods

In April 2021, the National Institute for Food and Drug Surveillance (INVIMA) reported an outbreak of R. pickettii infection associated with contaminated intravenous medications. The Municipal Health Department began collecting data for all cases identified by the hospitals and the results of microbiological studies. Medical records and death certificates of included cases were reviewed.

Results

Between March and May 2021, 66 cases of R. pickettii bloodstream infections from nine hospitals were documented. The median age of the patients was 60 years (IQR 51-72), and most of them had comorbidities (78.8%), mainly arterial hypertension and diabetes mellitus. At the time of the R. pickettii bloodstream infection, 89.4% had COVID-19, 86.4% were on mechanical ventilation, and 98.5% were receiving corticosteroids. The overall mortality was 81.8%. Nearly 60% of the deaths were related to R. pickettii bloodstream infections. R. pickettii was identified in the cultures from intravenous medications.

Conclusions

This large multicenter outbreak caused by intravenous medications contaminated with R. pickettii mainly affected critically ill COVID-19 patients. Mortality was high and largely related to R. pickettii bloodstream infection.

Epidemiology of 4963 deaths associated with COVID-19 during three pandemic waves in a Latin American city with a high mortality rate, 2020-2021

OBJECTIVE

To describe the characteristics of SARS-CoV-2-associated deaths in Barranquilla, Colombia, a city with a high mortality rate, and their changes between pandemic waves.

METHODS

The local Health Department obtained information on all laboratory-confirmed SARS-CoV-2 deaths reported from March 2020 through May 2021. Data were collected using national surveillance reports and death certificates.

RESULTS

4963 SARS-CoV-2-associated deaths were documented, for a mortality rate of 389.4 deaths per 100,000 population. 62% of all deaths occurred in people aged ≥65 years and 58% in males. Only 7 COVID-19-associated deaths in children were reported. Comorbidities were found in 47.9% of cases. The number of deaths among people aged 50-64 years increased significantly during the pandemic waves (from 25% to 29%). Conversely, the frequency of male sex (from 64.6% to 53.9%) and deaths with comorbidities (from 60.9% to 39.6%) decreased significantly between the waves of pandemic. Early mortality, defined as death within 48 h after hospital admission, was higher during the first pandemic wave than in the others (29.5%, 9.7% and 10.5%) and time from hospital admission to death increased during waves (from 9 to 14 days).

CONCLUSIONS

The COVID-19-associated mortality rate was high and mainly affects older people, with comorbidities and male sex. Early mortality was higher during the first wave. Women and healthy people without comorbidities died more frequently after the first pandemic wave.