The risk for further spread of hypervirulent Klebsiella pneumoniae (hvKp) sequence type (ST) 23 between healthcare facilities is deemed high, warned the European Centre for Disease Prevention and Control (ECDC).
In its rapid risk assessment, the ECDC reported that the number of European Union (EU) and European Economic Area (EEA) countries reporting hvKp ST23 had more than doubled, from four to 10, since the previous rapid risk assessment in 2021. These countries are Denmark, Finland, France, Hungary, Ireland, Italy, Latvia, Lithuania, the Netherlands, and Norway. Also, the number of total cases reported to the ECDC by these countries has increased from 12 to 143.
“The increases in cases of carbapenem-resistant hypervirulent Klebsiella pneumoniae (hvKp) reported to ECDC by EU/EEA countries is a cause for concern because of the severity of hvKp infections combined with their resistance to last-line antibiotics, which makes the infections difficult to treat,” said Dominique Monnet, ECDC head of section for antimicrobial resistance and healthcare-associated infections, in a press release.
Young and Healthy Also at RiskHvKp causes invasive infections, such as pneumonia or lung abscess, but is primarily associated with hepatic abscesses in both healthy and immunocompromised individuals. HvKp from these severe pyogenic liver abscesses often spreads to distant sites, leading to meningitis, necrotizing fasciitis, and endophthalmitis.
The ECDC pointed out that life-threatening hvKp infections may occur in young and healthy individuals and are associated with high morbidity and mortality, mainly due to the high invasiveness of the pathogen and rapid progression of the infection.
The first reports of hvKp were from Taiwan and Southeast Asia in the mid-1980s and 1990s.
A significant number of hvKp infections are community-acquired, which the ECDC said suggested that hvKp strains are circulating among healthy individuals.
HvKp infection causes a different spectrum of disease than the classic (non-hypervirulent) K pneumoniae that is better known to clinicians. Whereas classic K pneumoniae is an opportunistic pathogen typically affecting vulnerable patients with comorbidities in healthcare facilities, the hypervirulent organism has the ability to cause infections in previously healthy individuals. Another difference is that hvKp infection often presents at multiple sites and with metastatic spread.
Antibiotic Resistance ThreatIn the past, hvKp strains were primarily found in Asia, were mainly community-acquired, and were only rarely resistant to antibiotics. However, recent reports point to increasing geographic distribution, healthcare association, and multidrug resistance.
The increasing frequency of detection could partially be explained by increased laboratory capacity for molecular testing and an increased likelihood for detecting hvKp carrying carbapenemase genes with screening of patients, the ECDC suggested.
The ECDC raised a further concern that hvKp ST23 had increasingly acquired a variety of genes associated with resistance to carbapenems, a group of last-resort antibiotics used for the treatment of serious infections.
Spread of carbapenem-resistant hvKp in healthcare settings is expected to result in increased morbidity and mortality among vulnerable patient populations in these settings, the ECDC warned.
Heightened Awareness CrucialIt is highly likely that hvKp isolates and infections are currently underdetected, because detection of hypervirulence is not part of routine diagnostic microbiology. However, the ECDC pointed out that the clinical presentation and extended disease spectrum of hvKp has not been encountered by many clinicians.
There is therefore a need for increased clinical and public health awareness as well as increased laboratory capacity for the detection of hvKp to prevent further dissemination in healthcare settings and avoid further establishment of hvKp carrying carbapenemase genes, stressed the ECDC.
Response options include alerts to clinicians and clinical microbiology laboratories, the establishment of sufficient laboratory capacity to detect hvKp isolates, the submission of all suspected hvKp isolates with or without additional antimicrobial resistance to national reference laboratories, and enhanced infection prevention and control measures in healthcare facilities.
Prospective data collection on hvKp isolates, including epidemiologic and clinical data on cases of infection, carriage, and associated risk factors, would improve the understanding of national spread and transmission routes and determine the need for further surveillance, the ECDC explained.
Source : Medscape