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

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 s...

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Bibliographic Details
Published in:	Nature microbiology Vol. 4; no. 11; pp. 1919 - 1929
Main Authors:	David, Sophia, Reuter, Sandra, Harris, Simon R., Glasner, Corinna, Feltwell, Theresa, Argimon, Silvia, Abudahab, Khalil, Goater, Richard, Giani, Tommaso, Errico, Giulia, Aspbury, Marianne, Sjunnebo, Sara, Feil, Edward J., Rossolini, Gian Maria, Aanensen, David M., Grundmann, Hajo
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 01-11-2019 Nature Publishing Group
Subjects:	631/181/757 631/326/107 631/326/22/1434 631/326/41/2530 692/308/174 Bacterial Proteins Biomedical and Life Sciences Carbapenem-Resistant Enterobacteriaceae - classification Carbapenem-Resistant Enterobacteriaceae - genetics Carbapenemase Cross Infection - epidemiology Cross Infection - transmission Enterobacteriaceae Infections - epidemiology Enterobacteriaceae Infections - transmission Epidemics Epidemics - classification Epidemiology Europe - epidemiology Genetic analysis Genomes Hospitals Humans Infectious Diseases Klebsiella pneumoniae Life Sciences Medical Microbiology Medicin och hälsovetenskap Microbiology Molecular Epidemiology Parasitology Phylogeny Polymorphism, Single Nucleotide Propensity Score Public health Sequence Analysis, DNA Single-nucleotide polymorphism Virology β-Lactam antibiotics Europe
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Summary:	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. Genomic and epidemiological analysis of carbapenem-resistant Klebsiella pneumoniae across Europe finds increased transmissibility of four clonal lineages, especially between hospitals within countries.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2058-5276 2058-5276
DOI:	10.1038/s41564-019-0492-8