February 22, 2024. Expansion of hypervirulent Klebsiella pneumoniae (hvKp ST23).

February 22, 2024

The European Center for Disease Control and Prevention (ECDC) warns of a strain spreading across Europe Klebsiella pneumonia hypervirulent (hvKp ST23), resistant to carbapenems (an antibiotic used as one of the last lines). Hospital-acquired outbreaks of carbapenem-resistant HVKp have been associated with very high mortality.

Klebsiella pneumonia The hypervirulent virus has acquired a number of genes, meaning it affects not only people with weakened immune systems, but also healthy people. These are virulence genes that cause disease. In this case, yersiniabactin (ybt), colibactin (clb) and aerobactin (iuc). These three genes allow him to be more aggressive.

Currently, cases of transmission of the hvKp ST23-K1 line (globally dominant, carrying carbapenemase genes) have been confirmed in Ireland. France, Latvia and Lithuania are also under suspicion. Until now they have only been described in Asia (China).

Since the last ECDC rapid risk assessment in 2021, the number of European Union/European Economic Area (EU/EEA) countries reporting cases KLebsiella pneumonia hypervirulent (hvKp) sequential type (ST) 23 increased from four to ten countries, and the number of isolates tested by these countries increased from 12 to 143 isolates.

Moreover, there is now evidence of a steady spread of the global dominant lineage HVKP ST23-K1 transfer of carbapenemase genes among healthcare facilities in Ireland over a five-year period, despite improved control measures. Clusters of hvKp ST23-K1 isolates have also been detected in France, Latvia, and Lithuania, suggesting possible domestic transmission, although epidemiological data have not yet confirmed their more likely domestic transmission.

Similar spread within and between healthcare facilities may already have occurred in other EU/EEA countries where surveillance is less established. The appearance of insulations K. pneumonia with combined hypervirulence and resistance to last-line antibiotics such as carbapenems is of concern because, unlike the “classical” strains K. pneumoniaHvKp strains can cause serious infections in healthy people, often complicated by spread to multiple areas of the body.

Previously, hvKp strains were primarily found in Asia, were primarily acquired through community transmission, and were rarely resistant to antibiotics. However, recent reports indicate an increase in geographic distribution, healthcare association, and multidrug resistance. With the convergence of virulence and antimicrobial resistance in hvKp strains, the potential for infection exists. potentially incurable in previously healthy adults. Even greater morbidity and mortality should be expected if carbapenem-resistant hvKp strains spread in healthcare settings and affect vulnerable patient populations. Stable transmission of hvKp ST23 carrying carbapenemase genes was confirmed. between objects healthcare in an EU/EEA country.

Therefore, the likelihood of further spread and emergence of hvKp carrying carbapenemase genes in healthcare settings in EU/EEA countries with subsequent significant impact on morbidity and mortality is currently considered high. It is important to identify hvKp early and prevent further spread in healthcare settings in EU/EEA countries to prevent further spread of hvKp carrying carbapenemase genes as a healthcare associated pathogen.

Response options include alerting physicians and clinical microbiology laboratories, establishing sufficient laboratory potential for detection of hvKp isolates, including complete genome sequencing, reporting all suspected hvKp isolates with or without additional antimicrobial resistance to national reference laboratories, and strengthening infection prevention and control measures in health care settings. Prospective collection of data on hvKp isolates, including epidemiological and clinical data on infection, carriage and associated risk factors, will improve understanding of national patterns of spread and transmission and determine the need for further surveillance and control measures.

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Antibiotic resistance