1887
Surveillance Open Access
Like 0

Abstract

Background

Preliminary unpublished results of the survey of carbapenem- and/or colistin-resistant Enterobacterales (CCRE survey) showed the expansion of carbapenemase-producing (CPKP) sequence type (ST) 39 in 12 of 15 participating Greek hospitals in 2019.

Aim

We conducted a rapid survey to determine the extent of spread of CPKP high-risk clones in Greek hospitals in 2022 and compare the distribution of circulating CPKP clones in these hospitals since 2013.

Methods

We analysed whole genome sequences and epidemiological data of 310 isolates that were carbapenem-resistant or ‘susceptible, increased exposure’ from Greek hospitals that participated in the European survey of carbapenemase-producing (EuSCAPE, 2013–2014), in the CCRE survey (2019) and in a national follow-up survey (2022) including, for the latter, an estimation of transmission events.

Results

Five STs including ST258/512 (n = 101 isolates), ST11 (n = 93), ST39 (n = 56), ST147 (n = 21) and ST323 (n = 13) accounted for more than 90% of CPKP isolates in the dataset. While ST11, ST147 and ST258/512 have been detected in participating hospitals since 2013 and 2014, KPC-2-producing ST39 and ST323 emerged in 2019 and 2022, respectively. Based on the defined genetic relatedness cut-off, 44 within-hospital transmission events were identified in the 2022 survey dataset, with 12 of 15 participating hospitals having at least one within-hospital transmission event.

Conclusion

The recent emergence and rapid spread of new high-risk clones in the Greek healthcare system related to within-hospital transmission is of concern and highlights the need for molecular surveillance and enhanced infection prevention and control measures.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.47.2300571
2023-11-23
2024-02-28
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.47.2300571
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/47/eurosurv-28-47-3.html?itemId=/content/10.2807/1560-7917.ES.2023.28.47.2300571&mimeType=html&fmt=ahah

References

  1. Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998;11(4):589-603.  https://doi.org/10.1128/CMR.11.4.589  PMID: 9767057 
  2. Hauck C, Cober E, Richter SS, Perez F, Salata RA, Kalayjian RC, et al. . Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections. Clin Microbiol Infect. 2016;22(6):513-9.  https://doi.org/10.1016/j.cmi.2016.01.023  PMID: 26850824 
  3. European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment: carbapenem-resistant Enterobacteriaceae – second update. Stockholm: ECDC; 2019. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/carbapenem-resistant-enterobacteriaceae-risk-assessment-rev-2.pdf
  4. David S, Reuter S, Harris SR, Glasner C, Feltwell T, Argimon S, et al. Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread. Nat Microbiol. 2019;4(11):1919-29.  https://doi.org/10.1038/s41564-019-0492-8  PMID: 31358985 
  5. Brolund A, Lagerqvist N, Byfors S, Struelens MJ, Monnet DL, Albiger B, et al. Worsening epidemiological situation of carbapenemase-producing Enterobacteriaceae in Europe, assessment by national experts from 37 countries, July 2018. Euro Surveill. 2019;24(9):1900123.  https://doi.org/10.2807/1560-7917.ES.2019.24.9.1900123  PMID: 30862330 
  6. Grundmann H, Glasner C, Albiger B, Aanensen DM, Tomlinson CT, Andrasević AT, et al. Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study. Lancet Infect Dis. 2017;17(2):153-63.  https://doi.org/10.1016/S1473-3099(16)30257-2  PMID: 27866944 
  7. European Centre for Disease Prevention and Control (ECDC). ECDC study protocol for genomic-based surveillance of carbapenem-resistant and/or colistin-resistant Enterobacteriaceae at the EU level - version 2.0. Stockholm: ECDC; 2018. Available from: https://ecdc.europa.eu/en/publications-data/ecdc-study-protocol-genomic-based-surveillance-carbapenem-resistant-andor
  8. European Centre for Disease Prevention and Control (ECDC). Expert consensus protocol on carbapenem resistance detection and characterisation for the survey of carbapenem- and/or colistin-resistant Enterobacteriaceae. Stockholm: ECDC; 2019. Available from: https://ecdc.europa.eu/en/publications-data/expert-consensus-protocol-carbapenem-resistance-detection-and-characterisation
  9. European Centre for Disease Prevention and Control (ECDC). Expert consensus protocol on colistin resistance detection and characterisation for the survey of carbapenem- and/or colistin-resistant Enterobacteriaceae. Stockholm: ECDC; 2019. Available from: https://ecdc.europa.eu/en/publications-data/expert-consensus-protocol-colistin-resistance-detection-and-characterisation
  10. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 12.0, valid from 2022-01-01: EUCAST; 2022. Available at: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_12.0_Breakpoint_Tables.pdf
  11. Bankevich A, Nurk S, Antipov D, Gurevich AA, Dvorkin M, Kulikov AS, et al. SPAdes: a new genome assembly algorithm and its applications to single-cell sequencing. J Comput Biol. 2012;19(5):455-77.  https://doi.org/10.1089/cmb.2012.0021  PMID: 22506599 
  12. Argimón S, David S, Underwood A, Abrudan M, Wheeler NE, Kekre M, et al. Rapid genomic characterization and global surveillance of Klebsiella using Pathogenwatch. Clin Infect Dis. 2021;73(Suppl_4):S325-35.  https://doi.org/10.1093/cid/ciab784  PMID: 34850838 
  13. Diancourt L, Passet V, Verhoef J, Grimont PA, Brisse S. Multilocus sequence typing of Klebsiella pneumoniae nosocomial isolates. J Clin Microbiol. 2005;43(8):4178-82.  https://doi.org/10.1128/JCM.43.8.4178-4182.2005  PMID: 16081970 
  14. Lam MMC, Wick RR, Watts SC, Cerdeira LT, Wyres KL, Holt KE. A genomic surveillance framework and genotyping tool for Klebsiella pneumoniae and its related species complex. Nat Commun. 2021;12(1):4188.  https://doi.org/10.1038/s41467-021-24448-3  PMID: 34234121 
  15. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81.  https://doi.org/10.1111/j.1469-0691.2011.03570.x  PMID: 21793988 
  16. Arcari G, Carattoli A. Global spread and evolutionary convergence of multidrug-resistant and hypervirulent Klebsiella pneumoniae high-risk clones. Pathog Glob Health. 2023;117(4):328-41.  https://doi.org/10.1080/20477724.2022.2121362  PMID: 36089853 
  17. Peirano G, Chen L, Kreiswirth BN, Pitout JDD. Emerging antimicrobial-resistant high-risk Klebsiella pneumoniae clones ST307 and ST147. Antimicrob Agents Chemother. 2020;64(10):e01148-20.  https://doi.org/10.1128/AAC.01148-20  PMID: 32747358 
  18. Giakkoupi P, Papagiannitsis CC, Miriagou V, Pappa O, Polemis M, Tryfinopoulou K, et al. An update of the evolving epidemic of blaKPC-2-carrying Klebsiella pneumoniae in Greece (2009-10). J Antimicrob Chemother. 2011;66(7):1510-3.  https://doi.org/10.1093/jac/dkr166  PMID: 21543359 
  19. Karaiskos I, Daikos GL, Gkoufa A, Adamis G, Stefos A, Symbardi S, et al. Ceftazidime/avibactam in the era of carbapenemase-producing Klebsiella pneumoniae: experience from a national registry study. J Antimicrob Chemother. 2021;76(3):775-83.  https://doi.org/10.1093/jac/dkaa503  PMID: 33249436 
  20. Karampatakis T, Zarras C, Pappa S, Vagdatli E, Iosifidis E, Roilides E, et al. Emergence of ST39 carbapenem-resistant Klebsiella pneumoniae producing VIM-1 and KPC-2. Microb Pathog. 2022;162:105373.  https://doi.org/10.1016/j.micpath.2021.105373  PMID: 34954336 
  21. Räisänen K, Koivula I, Ilmavirta H, Puranen S, Kallonen T, Lyytikäinen O, et al. Emergence of ceftazidime-avibactam-resistant Klebsiella pneumoniae during treatment, Finland, December 2018. Euro Surveill. 2019;24(19):1900256.  https://doi.org/10.2807/1560-7917.ES.2019.24.19.1900256  PMID: 31088601 
  22. Galani I, Karaiskos I, Angelidis E, Papoutsaki V, Galani L, Souli M, et al. Emergence of ceftazidime-avibactam resistance through distinct genomic adaptations in KPC-2-producing Klebsiella pneumoniae of sequence type 39 during treatment. Eur J Clin Microbiol Infect Dis. 2021;40(1):219-24.  https://doi.org/10.1007/s10096-020-04000-9  PMID: 32729059 
  23. Han JH, Lapp Z, Bushman F, Lautenbach E, Goldstein EJC, Mattei L, et al. Whole-genome sequencing to identify drivers of carbapenem-resistant Klebsiella pneumoniae transmission within and between regional long-term acute-care hospitals. Antimicrob Agents Chemother. 2019;63(11):e01622-19.  https://doi.org/10.1128/AAC.01622-19  PMID: 31451495 
  24. Forde BM, Bergh H, Cuddihy T, Hajkowicz K, Hurst T, Playford EG, et al. Clinical implementation of routine whole-genome sequencing for hospital infection control of multi-drug resistant pathogens. Clin Infect Dis. 2023;76(3):e1277-84.  https://doi.org/10.1093/cid/ciac726  PMID: 36056896 
  25. European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment: Regional outbreak of New Delhi metallo-betalactamase-producing carbapenem-resistant Enterobacteriaceae, Italy, 2018-2019. Stockholm ECDC; 2019. Available from: https://ecdc.europa.eu/sites/portal/files/documents/04-Jun-2019-RRA-Carbapenems%2C%20Enterobacteriaceae-Italy.pdf
  26. European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment: Combined clonal and plasmid-mediated outbreak of carbapenemase-producing Enterobacterales, Lithuania, 2019-2020. Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/en/publications-data/combined-clonal-and-plasmid-mediated-outbreak-carbapenemase-producing
  27. Kohlenberg A, Monnet DL, Plachouras D, Candida auris survey collaborative group, Candida auris survey collaborative group includes the following national experts. Increasing number of cases and outbreaks caused by Candida auris in the EU/EEA, 2020 to 2021. Euro Surveill. 2022;27(46):2200846.  https://doi.org/10.2807/1560-7917.ES.2022.27.46.2200846  PMID: 36398575 
/content/10.2807/1560-7917.ES.2023.28.47.2300571
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error