Rise in hypervirulent, carbapenem-resistant Klebsiella noted in Europe

Carbapenem-resistant Klebsiella pneumoniae


European health officials warned today that a strain of hypervirulent, carbapenem-resistant Klebsiella pneumoniae appears to be spreading across the continent.

In a rapid risk assessment, the European Centre for Disease Prevention and Control (ECDC) said the number of European Union/European Economic Area (EU/EEA) countries reporting cases of hypervirulent K pneumoniae (hvKp) sequence type (ST)23 has increased from 4 to 10 since the last assessment in 2021, and the number of isolates submitted for analysis has increased from 12 to 143. Analysis of these isolates shows that the dominant lineage, hvKp ST23-K1, has acquired several carbapenem-resistance genes.

Despite enhanced control efforts, the ECDC said there's also been evidence of sustained spread of hvKp ST23-K1 between healthcare facilities within one country (Ireland), and clusters of cases in France, Latvia, and Lithuania that have not been epidemiologically confirmed but suggest potential within-country transmission.

Potentially untreatable infections

To date, hvKp strains have been found primarily in Asia and have mainly caused community-acquired infections, even among otherwise healthy people, which differentiates them from the "classic" K pneumoniae strains that typically cause infections in vulnerable, immune-compromised hospital patients. Invasive infections caused by hvKp strains, including pneumonia and liver abscesses, tend to progress rapidly, spread to other sites, and are associated with high morbidity and mortality.

But in recent years hvKp strains have begun to establish themselves in healthcare settings in Asia, and while initial strains were susceptible to antibiotics, they have acquired multiple antibiotic-resistance genes.

The ECDC report notes that the spectrum of carbapenemase genes detected in hvKp isolates in the EU/EEA has increased over the years, with some isolates carrying multiple carbapenemase genes. In addition, hvKp ST23 isolates with resistance to colistin and ceftazidime-avibactam have been reported.

The combination of hypervirulence with resistance to last-resort antibiotics has resulted in challenging, life-threatening, and potentially untreatable infections.

"The increase in cases of carbapenem-resistant hypervirulent Klebsiella pneumoniae (hvKp) reported to ECDC by EU/EEA countries is a cause for concern because of the severity of hvKp infections combined with their resistance to last-line antibiotics, which makes the infections difficult to treat," Dominique Monnet, PharmD, Phd, ECDC's head of its Section for Antimicrobial Resistance and Healthcare-associated Infections, said in a press release.

High risk of further hospital spread

The ECDC also said the population at risk from hvKp infections will likely be larger than the well-known high-risk groups for "classic" K pneumoniae infections, and that the probability of further spread in EU/EEA hospitals is considered to be high. In fact, the pathogen is likely already spreading in countries with less established surveillance, the report noted.

To prevent further dissemination of hvKp strains in healthcare settings, the ECDC is calling for enhanced infection prevention and control measures, increased clinical and public health awareness, increased laboratory capacity, and submission of all hvKp isolates to national reference laboratories.

"Prospective data collection on hvKp isolates, including epidemiological and clinical data on cases of infection, carriage and associated risk factors, would improve the understanding of national spread and transmission routes and determine the need for further surveillance," the agency said.

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