Carbapenem-resistant Enterobacterales (CRE), including carbapenem-resistant Klebsiella pneumoniae and carbapenem-resistant Escherichia coli, pose a major risk to patients and healthcare systems in the EU/EEA. In fact, according to an updated ECDC risk assessment the epidemiological situation has been deteriorating since 2019.
Carbapenem-resistant K. pneumoniae bloodstream infections have surged in 23 EU member states, driven by the continued spread of multidrug-resistant high-risk lineages in hospitals. In addition, some K. pneumoniae lineages that are more likely to cause severe diseases have also become resistant to carbapenems, including the hypervirulent lineage K. pneumoniae ST23. Newly emerging carbapenem-resistant Enterobacterales species (other than K. pneumoniae) are also spreading in hospitals.
Furthermore, isolates and small clusters of certain carbapenem-resistant E. coli strains are increasingly being detected, posing a risk for spread in the community.
'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. 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,' says Piotr Kramarz, ECDC Chief Scientist.
Although infection prevention and control (IPC) measures are essential to address the spread of CRE, their implementation in many hospitals is sub-optimal and insufficient to achieve sustained control of the high-risk lineages of carbapenem-resistant K. pneumoniae and other Enterobacterales.
Enhanced and coordinated efforts are therefore urgently required in all EU/EEA countries to address the inter-hospital and inter-regional spread of CRE.
ECDC recommends EU/EEA countries to:
- 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 hospitalisation 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 characterisation 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.
ECDC calls on 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.
