Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread

EuSCAPE Working Group, David, S., Reuter, S., Harris, S. R., Glasner, C., Feltwell, T., Argimon, S., Abudahab, K., Goater, R., Giani, T., Errico, G., Aspbury, M., Sjunnebo, S., Feil, E. J., Rossolini, G. M., Aanensen, D. M. & Grundmann, H., Nov-2019, In : Nature Microbiology. 4, 11, p. 1919-1929 14 p.

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  • Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread

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  • EuSCAPE Working Group
  • Sophia David
  • Sandra Reuter
  • Simon R Harris
  • Corinna Glasner
  • Theresa Feltwell
  • Silvia Argimon
  • Khalil Abudahab
  • Richard Goater
  • Tommaso Giani
  • Giulia Errico
  • Marianne Aspbury
  • Sara Sjunnebo
  • Edward J Feil
  • Gian Maria Rossolini
  • David M Aanensen
  • Hajo Grundmann

Public health interventions to control the current epidemic of carbapenem-resistant Klebsiella pneumoniae rely on a comprehensive understanding of its emergence and spread over a wide range of geographical scales. We analysed the genome sequences and epidemiological data of >1,700 K. pneumoniae samples isolated from patients in 244 hospitals in 32 countries during the European Survey of Carbapenemase-Producing Enterobacteriaceae. We demonstrate that carbapenemase acquisition is the main cause of carbapenem resistance and that 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. Combined analysis of the genetic and geographic distances between isolates with different β-lactam resistance determinants suggests that the propensity of K. 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. Finally, we propose a value of 21 for the number of single nucleotide polymorphisms that optimizes the discrimination of hospital clusters and detail the international spread of the successful epidemic lineage, ST258/512.

Original languageEnglish
Pages (from-to)1919-1929
Number of pages14
JournalNature Microbiology
Issue number11
Publication statusPublished - Nov-2019

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