Portal de Periódicos da CAPES

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

2019; Nature Portfolio; Volume: 4; Issue: 11 Linguagem: Inglês

10.1038/s41564-019-0492-8

2058-5276

Sophia David, Sandra Reuter, Simon R. Harris, Corinna Glasner, Theresa Feltwell, Silvia Argimón, Khalil Abudahab, Richard Goater, Tommaso Giani, Giulia Errico, Marianne Aspbury, Sara Sjunnebo, Andi Koraqi, Denada Lacej, Petra Apfalter, Rainer Hartl, Y. Glupczynski, Te‐Din Huang, Tanya Strateva, Y. Marteva-Proevska, Arjana Tambić Andrašević, Iva Butić, Despo Pieridou-Bagatzouni, Panagiota Maikanti-Charalampous, Jaroslav Hrabák, Helena Žemličková, Anette M. Hammerum, Lotte Jakobsen, Marina Ivanova, Anastasia Pavelkovich, Jari Jalava, Monica Österblad, Laurent Dortet, Sophie Vaux, Martin Kaase, Sören Gatermann, Alkiviadis Vatopoulos, Kyriaki Tryfinopoulou, Ákos Tóth, Laura Jánvári, Teck Wee Boo, Elaine McGrath, Yehuda Carmeli, Amos Adler, Annalisa Pantosti, Monica Monaco, Lul Raka, Arsim Kurti, Arta Balode, Māra Saule, Jolanta Miciulevičienė, Aistė Mierauskaitė, Monique Perrin-Weniger, Paul Reichert, Nina Nestorova, Sonia Debattista, Gordana Mijović, Milena Lopičić, Ørjan Samuelsen, Bjørg Haldorsen, Dorota Żabicka, Elżbieta Literacka, Manuela Caniça, Vera Manageiro, Ana Kaftandzieva, Elena Trajkovska-Dokic, Maria Damian, Brânduşa Elena Lixandru, Zora Jelesić, Anika Trudić, M Nikś, Eva Schréterová, Mateja Pirš, Tjaša Cerar, Jesús Oteo, Belén Aracil, Christian G. Giske, Karin Sjöström, Deniz Gür, Aslı Çakar, Neil Woodford, Katie L. Hopkins, Camilla Wiuff, Derek Brown, Edward J. Feil, Gian María Rossolini, David M. Aanensen, Hajo Grundmann,

Pneumonia and Respiratory Infections

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.