Increase of hypervirulent carbapenem-resistant Klebsiella pneumoniae in the EU/EEA
Since the most recent ECDC rapid risk assessment in 2021, the number of European Union (EU) and European Economic Area (EEA) countries reporting hypervirulent Klebsiella pneumoniae (hvKp) sequence type (ST) 23 has increased from four to ten and the number of cases reported to ECDC by the countries, increased from 12 to 143.
This information is presented in an update of the ECDC Rapid Risk Assessment on Emergence of hypervirulent Klebsiella pneumoniae ST23 carrying carbapenemase genes in EU/EEA countries.
Another cause for concern is that hvKp ST23 has increasingly acquired a variety of genes associated with resistance to carbapenems, a group of last-resort antibiotics used for the treatment of serious infections
Dominique Monnet, ECDC, Head of Section Antimicrobial Resistance and Healthcare-Associated Infections says:
“The increases 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,”
Spread of carbapenem-resistant hvKp in healthcare settings is expected to result in increased morbidity and mortality among vulnerable patient populations in these settings.
The updated Rapid Risk Assessment provides evidence of the sustained spread of a specific lineage of hvKp ST23 (lineage K1) between healthcare facilities within one EU/EEA country over a five-year period, despite enhanced control efforts. Clusters of hvKp ST23-K1 cases signalling potential within-country transmission were also detected in three other EU/EEA countries; however, these clusters have so far not been confirmed with detailed epidemiological investigations.
Nevertheless, as the risk for further spread of hvKp ST23-K1 between healthcare facilities is deemed high, ECDC calls for mitigation actions.
Recommended measures include alerts to clinicians and clinical microbiology laboratories, establishment of sufficient laboratory capacity to detect hvKp isolates including whole genome sequencing, submission of all suspected isolates to National Reference Laboratories, and enhanced infection prevention and control measures in affected healthcare facilities..
In the past, 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.
Collection of additional data on hvKp cases, including epidemiological data and data-associated risk factors, is required to better understand national spread and transmission routes, and determine the need for further surveillance and control measures.
