The rise of carbapenem-resistant strains of Klebsiella pneumoniae in Europe is being driven by nosocomial spread, according to new research published in Nature Microbiology.
Researchers analysed genome sequences and epidemiological data of 1717 pneumoniae samples isolated from patients in 244 hospitals in 32 countries during the European Survey of Carbapenemase-Producing Enterobacteriaceae.
They demonstrated that carbapenemase acquisition is the main cause of carbapenem resistance and 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. Most of the high-incidence European countries that reported a rapid rise in carbapenem resistance over the past 15 years witnessed epidemic expansion of ST258/512, the study noted.
Combined analysis of the genetic and geographic distances between isolates with different β-lactam resistance determinants suggests the propensity of Klebsiella 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,” said the researchers.
They emphasised the need for ongoing genomic pathogen surveillance, optimal infection control, and tight antibiotic stewardship.