Changing carbapenemase distribution in Klebsiella pneumoniae and Escherichia coli in the EU/EEA – preliminary results from the main collection of the CRE25 survey

It showed a decrease of the proportion of bla_KPC and an increase in the proportion of bla_NDM carbapenemase genes in comparison to the survey of carbapenem- and/or colistin-resistant Enterobacterales (CCRE survey) from 2019. The increase in the proportion of isolates with bla_NDM is driven by the spread of previously circulating K. pneumoniae high-risk lineages (e.g. sequence type (ST) 147) carrying bla_NDM, the emergence of new bla_NDM-positive high-risk lineages (e.g. ST383, ST395, ST6260) and the acquisition of bla_NDM by lineages (e.g. ST258/512) previously associated with other carbapenemase genes. Alongside ongoing dissemination of bla_NDM-1, a pronounced increase of bla_NDM-5 has been observed. The rising proportion of isolates carrying bla_NDM variants is of high concern as many newer antimicrobials developed for treating carbapenem-resistant Enterobacterales (CRE) infections, such as ceftazidime-avibactam, meropenem-vaborbactam and imipenem-relebactam, are not active against NDM-producing CRE. 

For the carbapenem-R/I Escherichia coli dataset, comparison of the results between surveys is more difficult due to the low number of carbapenem-R/I E. coli isolates in the previous CCRE survey. In contrast to K. pneumoniae SC, there is mainly an increase in the proportion of the bla_OXA-48-like carbapenemase genes primarily caused by increased detection of bla_OXA-244 in E. coli isolates of extraintestinal pathogenic high-risk lineages (e.g. ST38, ST131, ST13730, ST69, ST10) which are known to spread in the community as well as in healthcare settings. The increase in the proportion of E. coli isolates carrying bla_OXA-244 is of concern due to the potential for undetected transmission of these isolates in community settings. Enhanced efforts are required to control and reduce harm related to the spread of carbapenemase-producing Enterobacterales (CPE) in the European Union/European Economic Area. These efforts should include:

• improving national coordination and support to hospitals for implementing control measures;
• developing national CPE management plans;
• implementing enhanced infection prevention and control measures and antimicrobial stewardship programmes;
• strengthening laboratory capacity for rapid detection and characterisation of CPE, including genomic surveillance;
• strengthening innovation and access to antimicrobials indicated against CPE infections.