Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread

By S. David, S. Reuter, Simon R. Harris, C. Glasner, T. Feltwell, S. Argimón, K. AbuDahab, Richard J. Goater, Tommaso Giani, G. Errico and 78 more. Nature Microbiology, 2019

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Public health interventions to control the current epidemic of carbapenem-resistant Klebsiella pneumoniae rely on a comprehensive understanding of its emergence and spread over a wide range of geographical scales. We analysed the genome sequences and epidemiological data of >1,700 K. pneumoniae samples isolated from patients in 244 hospitals in 32 countries during the European Survey of Carbapenemase-Producing Enterobacteriaceae. We demonstrate that carbapenemase acquisition is the main cause of carbapenem resistance and that it occurred across diverse phylogenetic backgrounds. However, 477 of 682 (69.9%) carbapenemase-positive isolates are concentrated in four clonal lineages, sequence types 11, 15, 101, 258/512 and their derivatives. Combined analysis of the genetic and geographic distances between isolates with different β-lactam resistance determinants suggests that the propensity of K. pneumoniae to spread in hospital environments correlates with the degree of resistance and that carbapenemase-positive isolates have the highest transmissibility. Indeed, we found that over half of the hospitals that contributed carbapenemase-positive isolates probably experienced within-hospital transmission, and interhospital spread is far more frequent within, rather than between, countries. Finally, we propose a value of 21 for the number of single nucleotide polymorphisms that optimizes the discrimination of hospital clusters and detail the international spread of the successful epidemic lineage, ST258/512. Genomic and epidemiological analysis of carbapenem-resistant Klebsiella pneumoniae across Europe finds increased transmissibility of four clonal lineages, especially between hospitals within countries.

Subfields: Applied Microbiology and Biotechnology, Epidemiology, Molecular Medicine

View Paper: https://www.semanticscholar.org/paper/6d83b0ee2958d9e97767cebf745f0921ac02d39c

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Citations in the corpus

• ESKAPE pathogens: antimicrobial resistance, epidemiology, clinical impact and therapeutics (2024, positive): “Although CG258 is also the most prevalent carbapenem-resistant clone in Europe, there is a greater diversity of STs and carbapenemases that cluster geographically 88 .”
• Epidemiology of β-Lactamase-Producing Pathogens (2020, background): “pneumoniae, originating in the United States, was identified as the likely progenitor of the large majority of European carbapenemase-producing isolates (215).”