๐ก In a recent inquiry from Ireland reported in the ECDCโs Epidemic Intelligence Information System (EPIS), the isolation of hypervirulent ๐๐ญ๐ฆ๐ฃ๐ด๐ช๐ฆ๐ญ๐ญ๐ข ๐ฑ๐ฏ๐ฆ๐ถ๐ฎ๐ฐ๐ฏ๐ช๐ข๐ฆ (๐ฉ๐ท๐๐ฑ) ๐๐23 was documented. This hvKp strain exhibited a concerning combination of hypervirulence and resistance to carbapenem antibiotics, presenting a potential threat to public health. The study aimed to analyze the genomic data of hvKp ST23 isolates, understand the epidemiology, and propose response strategies.
๐ Key Findings:
๐ Emergence of hvKp ST23 in Europe: Ireland reported hvKp ST23 isolates from diagnostic and surveillance samples since March 2019. Analysis included additional hvKp ST23 genomes from public databases (n=26) and NRL submissions (n=12). Distinct geographical clusters and sporadic cases were observed, indicating potential local transmission.
๐ Carbapenemase Genes and Resistance: Several isolates in the EU/EEA carried carbapenemase genes, predominantly blaOXA-48. The convergence of hypervirulence and carbapenem resistance raises concerns about difficult-to-treat infections.
๐ Geographic Distribution and Multidrug Resistance: HvKp strains were traditionally found in Asia, mainly community-acquired, and rarely resistant. Recent reports indicate increasing geographic distribution, healthcare association, and multidrug resistance.
๐ Clinical Implications: HvKp strains can cause severe infections in healthy individuals and may disseminate to various body sites. The potential for untreatable infections in previously healthy adults is heightened with the emergence of carbapenem-resistant hvKp.
๐ Risk in Healthcare Settings: While the current risk associated with carbapenemase-producing hvKp is considered moderate, it may elevate in the future. Preventive measures are crucial to avoid establishing hvKp ST23 as a healthcare-associated pathogen.
๐ Response Options: Urgent alerts to clinicians and microbiology laboratories are recommended. Enhanced laboratory capacity is essential for detecting hvKp isolates. Submission of suspected hvKp isolates to National Reference Laboratories for further analysis is advised.
๐ Data Collection and Surveillance: Prospective data collection on hvKp, including epidemiological information and risk factors, is crucial.
Understanding national spread and transmission routes will guide surveillance and control measures.
๐ Genomic Analysis: Genomic analysis involved assembling raw reads, pseudonymizing genomes, and comparing against known ๐๐ญ๐ฆ๐ฃ๐ด๐ช๐ฆ๐ญ๐ญ๐ข ๐ฑ๐ฏ๐ฆ๐ถ๐ฎ๐ฐ๐ฏ๐ช๐ข๐ฆ (๐ฉ๐ท๐๐ฑ) ๐๐23 genomes. Pathogenwatch, Kleborate, and Microreact were used for antimicrobial resistance and virulence gene identification.
๐ Geographic Distribution of Genomes: Of the 195 analyzed genomes, 26 were from EU/EEA countries, with France reporting the highest number (n=9). Geographic distribution included Asia, EU/EEA, non-EU/EEA European countries, America, Oceania, and Africa.
๐ This report highlights the alarming emergence of hypervirulent ๐๐ญ๐ฆ๐ฃ๐ด๐ช๐ฆ๐ญ๐ญ๐ข ๐ฑ๐ฏ๐ฆ๐ถ๐ฎ๐ฐ๐ฏ๐ช๐ข๐ฆ (๐ฉ๐ท๐๐ฑ) ๐๐23 with carbapenem resistance in Europe. The combination of hypervirulence and resistance to key antibiotics poses a significant public health threat. Urgent response measures, enhanced surveillance, and international collaboration are essential to curb the potential spread of this multidrug-resistant pathogen in healthcare settings. Further studies are warranted to determine the prevalence and assess the risk associated with hvKp ST23 in the EU/EEA.
Link to the article : Emergence of hypervirulent Klebsiella pneumoniae ST23 carrying carbapenemase genes in EU/EEA countries (europa.eu)
