A study published late last week in Eurosurveillance describes the identification and rapid growth of a highly resistant Klebsiella pneumoniae strain in France.

The strain was identified from an analysis of clinical and screening specimens received by the French National Reference Center for Antibiotic Resistance (NRC) from June 2014 to June 2022. Of the 431 isolates of K pneumoniae sequence type (ST)147, which has been identified as a major public health threat owing to its high level of antibiotic resistance and increased virulence, 37 were non-duplicate New Delhi metallo-beta-lactamase (NDM)-14–producers.

The isolates were cultured from rectal swabs, urine samples, blood draws, respiratory tract samples, and wounds.

Although many other NDM variants, such as NDM-1 and NDM-5, were commonly found among the carbapenemase-producing K pneumoniae isolates over the study period, the first 6 NDM-14–producers appeared at NRC in 2021, with 31 collected in 2022.

Strain likely originated in Morocco

Whole-genome sequencing revealed that all the NDM-14­–producing isolates were closely related, part of the same cluster, and were associated with several hospital outbreaks in which the index patient was directly repatriated from Morocco, particularly the Casablanca region. Bayesian analysis estimated that the first NDM-14–producing K pneumoniae strain appeared in the country in 2020 and has rapidly evolved since then, with NDM-14 accounting for 41.3% of carbapenemases in K pneumoniae ST147 isolated collected by NRC in 2022.

Highly resistant NDM-14 producing K. pneumoniae can rapidly spread in healthcare settings.

Antimicrobial susceptibility testing showed that all NDM-14–producing isolates were highly resistant to all antimicrobials tested except colistin, cefiderocol, and the combination of aztreonam/avibactam, and 37 of 39 isolates possessed a high virulence score.

"Highly resistant NDM-14 producing K. pneumoniae can rapidly spread in healthcare settings," the study authors wrote. "Surveillance and thorough investigations of hospital outbreaks are critical to evaluate and limit the dissemination of this clone."

Minnesota and South Dakota reported more highly pathogenic avian flu outbreaks on turkey farms, and Iowa reported its first outbreak—also at a turkey farm—since March, according to notifications from federal and state agriculture agencies.

Minnesota reported two new outbreaks at commercial turkey producers, this time in Blue Earth and Redwood counties, according to the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS). Also, the state reported an outbreak on a poultry breeding farm in Becker County. As part of a recent small but steady uptick in outbreaks nationally, Minnesota has reported six outbreaks on commercial farms since early October.

South Dakota reported an outbreak at a turkey farm in Spink County, its fourth of the month. Also, the Iowa State Department of Agriculture and Land Stewardship announced on October 20 that high-path avian flu has been confirmed on a commercial turkey farm in Buena Vista County.

In other developments, Montana and Oregon reported outbreaks in poultry flocks, Oregon in Union County and Montana in Park County, apparently involving backyard birds, according to APHIS.

Since early 2022, the outbreaks have led to a record loss of 59.4 million birds across 47 states, including 10 over the past 30 days.

Over half of US state and territorial public health preparedness directors (PHPDs) surveyed said they experienced shortages of flu antiviral drugs such as oseltamivir (Tamiflu) during the 2022-23 respiratory virus season, forcing many to turn to national or state stockpiles, according to a research letter published late last week in JAMA.

Researchers from the Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Health Officials surveyed 38 PHPDs from states, territories, and large independent metropolitan health departments from January to August 2023. 

The 38 PHPDs represented all 10 US Department of Health and Human Services (HHS) regions, although the anonymous nature of the survey precluded identifying specific jurisdictions.

In December 2022, the CDC issued a public health advisory encouraging prioritization of oseltamivir for hospitalized flu patients, as well as outpatients at increased risk for severe illness. HHS's Administration for Strategic Preparedness and Response for the first time allowed jurisdictions to access Tamiflu from state, territorial, or national stockpiles.

Early, more active flu season

Twenty respondents (52.6%), including at least one in each HHS region, said certain formulations of oseltamivir, baloxavir, and zanamivir were in limited supply.

Sixteen respondents (42.1%) said that, amid the shortages, local clinicians and public health officials promoted flu vaccination. Thirteen PHPDs (34.2%) reported flu outbreaks in long-term care facilities, with no access to oseltamivir for symptomatic residents or prevention in those exposed to the virus.

It is possible that local antiviral shortages were due to earlier and higher than expected influenza activity in the 2022-2023 influenza season compared with the 2020-2021 and 2021-2022 influenza seasons,

Of 22 PHPDs in states or territories with stockpiles for pandemic flu, 10 (45.5%) reported obtaining stockpiled oseltamivir in response to shortages. Seven of 15 respondents (46.7%) in jurisdictions with no stockpile said they requested oseltamivir from the Strategic National Stockpile.

"It is possible that local antiviral shortages were due to earlier and higher than expected influenza activity in the 2022-2023 influenza season compared with the 2020-2021 and 2021-2022 influenza seasons, with consequent higher demand for oseltamivir," the study authors wrote, adding that the results highlight the need to monitor local and national antiviral supply distribution.