European CDC: Carbapenem Resistant Enterobacterales Poses a Significant Threat
The agency pointed pathogens such as Klebsiella pneumoniae and Escherichia coli (E coli) are problematic for healthcare systems and the general public across Europe.
Image credit: USGS
Yesterday, the European Center for Disease Prevention and Control (ECDC) published an assessment warning the public that the probability of carbapenem-resistant Enterobacterales (CRE) was spreading in the European Union/European Economic Area (EU/EEA) countries was high. The last update of ECDC’s rapid risk assessment on CRE was published in 2019. ECDC said the epidemiological situation has been deteriorating since then.1
In its assessment, the European agency wrote: “(a) an increase in the incidence of carbapenem-resistant K pneumoniae bloodstream infections in 23 EU Member States due to continued transmission of high-risk lineages of carbapenem-resistant K pneumoniae in hospitals; (b) convergence of virulence and resistance in K pneumoniae, including healthcare-associated spread of hypervirulent K pneumoniae ST23 carrying carbapenemase genes; (c) newly emerging Enterobacterales species carrying carbapenemase genes; (d) plasmid-mediated spread of carbapenemase genes causing outbreaks within hospitals and across healthcare networks, and (e) increasing detection of isolates (including isolated cases and clusters) of high-risk lineages of E coli carrying carbapenemase genes with a risk of spread in the community.”1
“These findings indicate a high probability of further spread of CRE in the EU/EEA, both in hospital settings and in community, a worrying trend since CRE infections are linked to high mortality,” Piotr Kramarz, ECDC chief scientist, said in a statement.2
Studies show varying mortality rates ranging from 30%-80% depending on patient factors. One multicenter study found that the 30-day mortality rate for CRE bacteremia was 50.6%.3
ECDC is asking all EU/EEA countries and hospitals to intensify their efforts to address this deteriorating epidemiological situation, mitigate the high risk of further CRE spread and, ultimately, protect patients and communities.
Preventative Strategies
In light of this assessment, the ECDC provided some recommendations for EU/EEA countries to follow. Their recommendations include:
- Strengthen national coordination of control measures between hospitals and regions and support hospitals in the implementation of these measures. If not already in place, a dedicated multidisciplinary national management team should be set up at the appropriate national level and a CRE action plan established, outlining targets, action, timelines and budget, and including regular public reporting on progress.
- Implement enhanced IPC measures in hospitals to interrupt transmission of carbapenem-resistant K pneumoniae and other CRE, including pre-emptive isolation and screening of patients for asymptomatic CRE carriage upon hospital admission, based on their hospitalization history for the previous 12 months.
- Apply antimicrobial stewardship to preserve the effectiveness of the carbapenems and the newly approved antimicrobials. This includes national treatment guidelines for CRE infections and audits of their implementation.
- Strengthen surveillance, including near real-time whole-genome sequencing to support the detection of CRE outbreaks, sources and transmission patterns. This approach also supports early detection of carbapenem-resistant E coli spread in community.
- Provide adequate laboratory capacity for rapid detection and characterization of CRE, including antimicrobial susceptibility testing and identification of carbapenemase genes for the targeted use of newly approved antimicrobials.
- Strengthen innovation and access to antimicrobials indicated against CRE infections.
CRE in Europe and the US
The European Antimicrobial Resistance Surveillance Network (EARS-Net) is a network of laboratories that collect data on antimicrobial resistance (AMR) in Europe. Based on the network’s data, the average rate of carbapenem resistance in invasive Klebsiella pneumoniae isolates across Europe is approximately 7%, and for E coli, the average is significantly lower at around 0.1%, highlighting a large disparity in resistance levels between these bacterial species. In addition, there is considerable variation in resistance rates depending on the country analyzed.4
“Even though several new antibiotics are available, treatment options remain limited overall. Immediate action is essential to control this problem and protect patients from infections that are becoming increasingly difficult to treat,” ECDC's Kramarz said.2
In the US, CRE caused about 13,100 infections in hospital patients and about 1,100 deaths in 2017, according to the CDC.5
To read the ECDC assessment, go to this page.
