Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread
Journal
Nature Microbiology
Date Issued
2019-11
Author(s)
Sophia David
Sandra Reuter
Simon R. Harris
Corinna Glasner
*The European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) Working Group
DOI
10.1038/s41564-019-0492-8
Abstract
Public health interventions to control the current epidemic of carbapenem-resistant Klebsiella
pneumoniae are reliant upon a comprehensive understanding of their emergence and spread over a
wide range of geographical scales. We analysed the genome sequences and epidemiological data
of >1700 K. pneumoniae, isolated from patients in 244 hospitals in 32 countries, during the
European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE). We demonstrate
that carbapenemase acquisition is the main cause of carbapenem resistance and has occurred
across diverse phylogenetic backgrounds. However, 477/682 (69.9%) of carbapenemase-positive
isolates are concentrated in four clonal lineages, sequence types (ST) 11, 15, 101, 258/512, and
their derivatives. Combined analysis of the genetic and geographic distances between isolates with
different beta-lactam resistance determinants suggests that the propensity of K. pneumoniae to
spread in hospital environments correlates with the degree of resistance and that carbapenemasepositive isolates have the highest transmissibility. Indeed, we found that over half of hospitals
contributing carbapenemase-positive isolates likely experienced within-hospital transmission, and
inter-hospital spread is far more frequent within, rather than between, countries. Finally, we
propose a value of 21 for the number of single nucleotide polymorphisms (SNPs) that optimises
discrimination of hospital clusters, and detail the international spread of the successful epidemic
lineage, ST258/512.
pneumoniae are reliant upon a comprehensive understanding of their emergence and spread over a
wide range of geographical scales. We analysed the genome sequences and epidemiological data
of >1700 K. pneumoniae, isolated from patients in 244 hospitals in 32 countries, during the
European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE). We demonstrate
that carbapenemase acquisition is the main cause of carbapenem resistance and has occurred
across diverse phylogenetic backgrounds. However, 477/682 (69.9%) of carbapenemase-positive
isolates are concentrated in four clonal lineages, sequence types (ST) 11, 15, 101, 258/512, and
their derivatives. Combined analysis of the genetic and geographic distances between isolates with
different beta-lactam resistance determinants suggests that the propensity of K. pneumoniae to
spread in hospital environments correlates with the degree of resistance and that carbapenemasepositive isolates have the highest transmissibility. Indeed, we found that over half of hospitals
contributing carbapenemase-positive isolates likely experienced within-hospital transmission, and
inter-hospital spread is far more frequent within, rather than between, countries. Finally, we
propose a value of 21 for the number of single nucleotide polymorphisms (SNPs) that optimises
discrimination of hospital clusters, and detail the international spread of the successful epidemic
lineage, ST258/512.
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