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Carbapenem resistance in Enterobacteriaceae such as Klebsiella pneumoniae and Escherichia coli poses a significant threat to patients and healthcare systems in all European Union/European Economic Area (EU/EEA) countries. Carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with high mortality, primarily due to delays in administration of effective treatment and the limited availability of treatment options. Hypervirulent carbapenem-resistant K. pneumoniae strains have been reported presenting an additional threat with a potential for global dissemination. The spread of high risk clones and plasmids carrying carbapenemases in healthcare settings is a major cause of the spread of CRE in EU/EEA countries. Recent events of cross-border importation after patient transfer and large regional outbreaks as well as the worsening epidemiologic situation of carbapenemase-producing CRE in the EU/EEA highlight the high risk for further spread of CRE and the need for enhanced control efforts. Options for control are outlined in the respective section below.

Data are processed for the conduct of the carbapenem- and/or colistin-resistant Enterobacteriaceae (CCRE) survey as part of molecular surveillance of antimicrobial resistant pathogens according to a protocol. For the CCRE survey bacterial isolates (carbapenem and/or colistin-resistant Enterobacteriaceae and susceptible control isolates) and related patient data are collected in hospitals in 37 countries with the aim to determine transmission pathways and improve control measures.

A large outbreak of New Delhi metallo-beta-lactamase (NDM)-producing carbapenem-resistant Enterobacteriaceae (CRE) has been reported from the Tuscany region in Italy. Between November 2018 and May 2019, seven Tuscan hospitals notified a total of 350 cases.

This protocol is based partly on the laboratory manual developed for the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE)

An ECDC country visit team conducted an assessment mission during the period 12–16 March 2018 to discuss antimicrobial resistance (AMR) issues in Norway. The overall objective of the mission was to provide an observation-based assessment of the situation in Norway regarding prevention and control of AMR through prudent use of antibiotics and infection control.

This ECDC study protocol describes the technical requirements for implementing future EU-level genomic-based surveillance of carbapenem-resistant and/or colistin-resistant Enterobacteriaceae.

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 8-14 July 2018 and includes updates on carbapenemase-producing (OXA-48) Klebsiella pneumoniae, dengue, Ebola virus disease, poliomyelitis, MERS-CoV, mass gathering monitoring (FIFA Men's Football World Cup), measles, poliovirus type 2, rubella, Vibrio growth in the Baltic Sea, and West Nile virus.

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 3-9 June 2018 and includes updates on dengue, Vibrio growth in the Baltic Sea, measles, rubella, hepatitis A, mass gathering monitoring, Carbapenem-resistant Enterobacteriaceae, Ebola virus disease, West Nile virus, polio and MERS-CoV.

This update of the 2016 ECDC Rapid Risk Assessment on carbapenem-resistant Enterobacteriaceae (CRE) evaluates the risk for patients and healthcare systems in EU/EEA countries due to the global spread of CRE.