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. 2023 Nov;28(47):2300571.
doi: 10.2807/1560-7917.ES.2023.28.47.2300571.

Emergence and persistent spread of carbapenemase-producing Klebsiella pneumoniae high-risk clones in Greek hospitals, 2013 to 2022

Kyriaki Tryfinopoulou  1   2 , Marius Linkevicius  1   3 , Olga Pappa  2 , Erik Alm  3 , Kleon Karadimas  2 , Olov Svartström  3 , Michalis Polemis  2 , Kassiani Mellou  2 , Antonis Maragkos  2 , Alma Brolund  4 , Inga Fröding  4 , Sophia David  5 , Alkiviadis Vatopoulos  6 , Daniel Palm  3 , Dominique L Monnet  3 , Theoklis Zaoutis  2 , Anke Kohlenberg  3 ; Greek CCRE study group  7 ; Members of the Greek CCRE study group
Collaborators, Affiliations

Emergence and persistent spread of carbapenemase-producing Klebsiella pneumoniae high-risk clones in Greek hospitals, 2013 to 2022

Kyriaki Tryfinopoulou et al. Euro Surveill. 2023 Nov.

Abstract

BackgroundPreliminary unpublished results of the survey of carbapenem- and/or colistin-resistant Enterobacterales (CCRE survey) showed the expansion of carbapenemase-producing Klebsiella pneumoniae (CPKP) sequence type (ST) 39 in 12 of 15 participating Greek hospitals in 2019.AimWe conducted a rapid survey to determine the extent of spread of CPKP high-risk clones in Greek hospitals in 2022 and compare the distribution of circulating CPKP clones in these hospitals since 2013.MethodsWe analysed whole genome sequences and epidemiological data of 310 K. pneumoniae isolates that were carbapenem-resistant or 'susceptible, increased exposure' from Greek hospitals that participated in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE, 2013-2014), in the CCRE survey (2019) and in a national follow-up survey (2022) including, for the latter, an estimation of transmission events.ResultsFive K. pneumoniae STs including ST258/512 (n = 101 isolates), ST11 (n = 93), ST39 (n = 56), ST147 (n = 21) and ST323 (n = 13) accounted for more than 90% of CPKP isolates in the dataset. While ST11, ST147 and ST258/512 have been detected in participating hospitals since 2013 and 2014, KPC-2-producing ST39 and ST323 emerged in 2019 and 2022, respectively. Based on the defined genetic relatedness cut-off, 44 within-hospital transmission events were identified in the 2022 survey dataset, with 12 of 15 participating hospitals having at least one within-hospital transmission event.ConclusionThe recent emergence and rapid spread of new high-risk K. pneumoniae clones in the Greek healthcare system related to within-hospital transmission is of concern and highlights the need for molecular surveillance and enhanced infection prevention and control measures.

Keywords: KPC; NDM; carbapenem-resistant Enterobacterales; carbapenemase; surveillance; whole genome sequencing.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Core-genome single nucleotide polymorphism-based phylogenetic tree of carbapenem-R/I Klebsiella pneumoniae isolates collected in 15 hospitals participating in two ECDC surveys and a national follow-up survey, Greece, 2013–2022 (n = 310)
Figure 2
Figure 2
Distribution of the five most frequent sequence types of carbapenem-R/I Klebsiella pneumoniae isolates collected in 15 hospitals participating in two ECDC surveys and a national follow-up survey, Greece, 2013–2022 (n = 310)
Figure 3
Figure 3
Distribution of the five most frequent sequence types of carbapenem-R/I Klebsiella pneumoniae isolates collected in 15 hospitals participating in the CCRE survey and a national follow-up survey, Greece, 2013–2022 (n = 270)
Figure 4
Figure 4
Distribution of carbapenemases by sequence type of carbapenem-R/I Klebsiella pneumoniae isolates collected in 15 hospitals participating in two ECDC surveys and a national follow-up survey, Greece, 2013–2022 (n = 310)
Figure 5
Figure 5
Comparison of ‘same hospital’/’different hospitals’ isolate pairs using Pathogenwatch core genome single-nucleotide polymorphisms (cgSNPs)
See this image and copyright information in PMC

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