Credit EID Journal
#15,873
While viral epidemics and pandemics currently get the bulk of our attention, they are not the only global health threats on the horizon. We are also faced with a growing array of multidrug resistant organisms (MDROs) - both bacterial and fungal - that already claim thousands of lives each year.
MDROs such as Candida auris, C. difficle, CRE, and MRSA cause significant morbidity and mortality in hospitalized patients, can be spread to other patients, staff, and even visitors, and are particularly problematic in nursing homes and LTCFs (Long Term Care Facilities).
Although most bacterial infections are still treatable - AMR (antimicrobial resistance) isn't some obscure future threat - as it already impacts millions of lives each year around the globe. In 2019, the CDC estimated that: More than 2.8 million antibiotic-resistant infections occur in the United States each year, and more than 35,000 people die as a result.
Each year we draw a little closer to a long-predicted, but highly plausible `post-antibiotic era', where even common infections become resistant to most antibiotics, and something as simple as a scraped knee, or elective surgery, could be deadly.
Of particular concern are reports of CRE (Carbapenem-resistant Enterobacteriaceae) colonization or infection. Enterobacteriaceae comprise a large family of Gram-negative bacteria that range from harmless strains to pathogenic invaders, and includes such familiar names as Salmonella, Escherichia coli, Klebsiella and Shigella.
Carbapenem-resistant Enterobacteriaceae are varieties that have developed resistance to a class of antibiotics called carbapenems, which are often the drug of last resort for treating difficult bacterial infections.
In recent years HvKp - a hypervirulent form of Klebsiella pneumoniae - most commonly reported in Asia, has drawn our attention. This highly invasive bacterial infection is increasingly showing signs of antibiotic resistance (see CIDRAP Hypervirulent, highly resistant Klebsiella identified in China).
- Last December, in EID Journal: COVID-19 and Fatal Sepsis Caused by Hypervirulent Klebsiella pneumoniae, Japan, 2020, we looked at an account of an elderly COVID patient in Japan who was co-infected with HvKp, a hypervirulent form of Klebsiella pneumoniae.
- In 2019, we looked at an outbreak Extensively drug-resistant (XDR) Klebsiella pneumonia in Europe involving (XDR) K. pneumoniae, affecting four hospitals in the northeast of the state of Mecklenburg-West Pomerania.
- And in Tracking CRE in the United States, the CDC lists K. pneumoniae carbapenemase (KPC) - which was first identified in the United States around 2001- as the most common carbapenemase in the United States.
Risk Assessment: Emergence of hypervirulent Klebsiella pneumoniae ST23 carrying carbapenemase genes in EU/EEA countries
Risk assessment
17 Mar 2021
This document assesses the risk associated with the dissemination of carbapenemase-producing hypervirulent Klebsiella pneumoniae (hvKp) of sequence type (ST) 23 and other STs in the European Union/European Economic Area (EU/EEA).
Executive summary
In an urgent inquiry in ECDC’s Epidemic Intelligence Information System (EPIS) Antimicrobial Resistance and Healthcare-Associated Infections (AMR-HAI) platform, Ireland reported the isolation of hypervirulent Klebsiella pneumoniae (hvKp) ST23, from diagnostic samples and from rectal or faecal samples collected for the surveillance of carriage of carbapenemase-producing Enterobacterales (CPE) since March 2019 with two distinct geographical clusters as well as sporadic cases.Information on further hvKp ST23 isolates detected in the European Union/European Economic Area (EU/EEA) were either found in public databases (n=26) or submitted by National Reference Laboratories (NRLs) in reply to a data request to the European Antimicrobial Resistance Genes Surveillance Network (EURGen-Net) (n=12). The analysis showed that several of the isolates detected in EU/EEA countries after 2012 carried carbapenemase genes, most frequently blaOXA-48.
This emergence of K. pneumoniae isolates with combined hypervirulence and resistance to reserve antibiotics such as carbapenems is of concern as, in contrast to ‘classic’ K. pneumoniae strains, hvKp strains are capable of causing severe infections in healthy individuals, often complicated by dissemination to various body sites.Previously, hvKp strains were primarily found in Asia, were mainly community-acquired, and were only rarely resistant to antibiotics. However, recent reports point to increasing geographic distribution, healthcare association and multidrug resistance. With the convergence of antimicrobial resistance and virulence in hvKp strains, there is a possibility of potentially untreatable (difficult-to-treat) infections in previously healthy adults. An even higher morbidity and mortality is to be expected if carbapenem-resistant hvKp strains spread in healthcare settings and affect a vulnerable patient population.Although only few cases and clusters have been reported in the EU/EEA to date, it is important to detect hvKp early and prevent further dissemination in healthcare settings in EU/EEA countries to avoid the establishment of carbapenemase-producing hvKp as a healthcare-associated pathogen similar to ‘classic’ carbapenemase-producing K. pneumoniae.The risk associated with the further dissemination of carbapenemase-producing hvKp for the patient population in the EU/EEA is currently considered to be moderate, but might become high in the future if hvKp ST23 is established in healthcare settings. Further studies are needed to determine the prevalence of hvKp ST23 in the EU/EEA.
Options for response include alerts to clinicians and clinical microbiology laboratories, the establishment of sufficient laboratory capacity to detect hvKp isolates, and the submission of all suspected hvKp isolates (for example, based on hypermucoviscosity and a positive string test) with or without additional antimicrobial resistance to National Reference Laboratories (NRLs) for further analysis. Prospective data collection on hvKp, including epidemiological data on cases and associated risk factors, would improve the understanding of national spread and transmission routes and determine the need for further surveillance and control measures.
Emergence of hypervirulent Klebsiella pneumoniae ST23 carrying carbapenemase genes in EU/EEA countries
Open file in new window - EN - [PDF-553.46 KB]
You'll also want to check out the CIDRAP-ASP Youtube Channel, which has more than 3 dozen lectures and webinars on Antimicrobial stewardship.Some of my more recent blogs on the threat of antibiotic resistance include:
WHO Update - Carbapenem-resistant Pseudomonas aeruginosa Infection – Mexico
UK Launches 5-year Action Plan Against Antimicrobial Resistance
WHO Report: Wide Differences In Antibiotic Use Between Countries
The Lancet: Attributable Deaths & Disability Due To Infections With Antibiotic-Resistant Bacteria - EU 2015
mBio: The Gathering Storm: Is Untreatable Typhoid Fever on the Way?
WHO: First Global Antimicrobial Surveillance System (GLASS) Report
