The European Centre for Disease Prevention and Control (ECDC) issued a warning today about a rising incidence of carbapenem-resistant Enterobacterales (CRE) infections, saying the risk of further spread is high.
In a rapid risk assessment, the ECDC said the epidemiologic situation has been deteriorating since 2019. Signs of deterioration include an increase in the incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in 23 European Union/European Economic Area (EU/EEA) nations due to the continued transmission of high-risk lineages of carbapenem-resistant K pneumoniae in hospitals. The agency also notes that a hypervirulent strain of K pneumoniae -- sequence type (ST)23 -- has become resistant to carbapenems.
In addition, the ECDC said carbapenemase genes have been identified in high-risk lineages of Escherichia coli that pose a risk for spread in the community, as well as in newly emerging Enterobacterales species.
CRE infections are resistant to multiple classes of antibiotics, leaving clinicians with few effective treatment options. As a result, CRE bloodstream infections are associated with a high level of attributable mortality.
"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," ECDC Chief Scientist Piotr Kramarz said in an ECDC press release. "Immediate action is essential to control this problem and protect patients from infections that are becoming increasingly difficult to treat."
The ECDC is urging EU/EEA countries to implement enhanced infection prevention and control efforts in hospitals to interrupt transmission of carbapenem-resistant K pneumoniae and other CRE, develop a CRE management plan, strengthen national coordination of control measures between hospitals and regions, bolster genomic surveillance, and apply antimicrobial stewardship to preserve the effectiveness of carbapenems.