Post by Nadica (She/Her) on Aug 1, 2024 21:49:43 GMT
WHO warns of increase in hypervirulent, multidrug-resistant Klebsiella strains - Published Aug 1, 2024
The World Health Organization (WHO) is warning countries about increasing reports of hypervirulent and multidrug-resistant Klebsiella pneumoniae (hvKp).
The warning is based on a global assessment the WHO conducted through its Global Antimicrobial Resistance and Surveillance System (GLASS), which issued a request for information earlier this year to all countries enrolled in the system after receiving reports of increased identification of hvKp isolates in several countries. Of the 43 countries and territories that responded to the WHO request, 16 reported the presence of hvKp strains.
In contrast to "classic" K pneumoniae, an opportunistic pathogen that is a leading cause of healthcare-associated infections and tends to cause infections in vulnerable, immunocompromised hospitalized patients, hvKp strains can cause severe invasive infections in healthy individuals that develop quickly and spread to various body sites. Infections caused by hvKp strains have been associated with high morbidity and mortality.
Although hvKp infections were initially found community settings in parts of Asia and were susceptible to antibiotics, recent reports have shown transmission of multidrug-resistant hvKp strains in healthcare settings in several countries.
Carbapenem-resistant hvKp strain raises concerns
The WHO is particularly concerned about one strain of hvKp, sequence type (ST)23, a strain that carries genes (carbapenemase genes) that confer resistance to carbapenem antibiotics and all available beta-lactam antibiotics. Experts say the combination of hypervirulence and carbapenem-resistance genes in K pneumoniae strains is worrisome.
"In general, carbapenem-resistant gram-negative bacteria are a major concern as the ability to treat them is severely constrained," Amesh Adalja, MD, FIDSA, a senior scholar at the Johns Hopkins University Center for Health Security, told CIDRAP News. "When you couple carbapenem-resistance with the hypervirulence exhibited by certain strains of K pneumoniae it is a recipe for increased morbidity and mortality from this bacterium."
In addition, the WHO noted that ST23 strains out-compete other gut bacteria, which can facilitate colonization and spread, and have the capacity to generate outbreaks. The WHO said in its assessment that with the concurrence of hypervirulence and antibiotic resistance, "it is expected that there will be an increased risk of spread of these strains at both the community and hospital levels."
Of the 16 countries that reported the presence of hvKp strains, 12 (Algeria, Argentina, Australia, Canada, India, Iran, Japan, Oman, Philippines, Switzerland, Thailand, and the United Kingdom) specifically reported the presence of the ST23-K1 strain. The United States is among the countries that reported the presence of hvKp strains.
When you couple carbapenem-resistance with the hypervirulence exhibited by certain strains of K pneumoniae it is a recipe for increased morbidity and mortality from this bacterium.
The WHO said the risk at the global level is moderate because there is currently no systematic surveillance for the routine identification, reporting, and monitoring of hvKp strains, and data on infections, hospitalizations, and the burden of disease are limited. Furthermore, many low-resource countries have limited diagnostic capacity and lack the molecular testing to identify virulence or resistance genes. And even in countries that have the ability to identify and analyze hvKp strains, the agency said, many physicians are unfamiliar with the clinical presentation of hvKp infections, and hvKp "may go unnoticed."
"The prevention and control of carbapenem-resistant hvKp poses significant challenges because it has not been possible to establish the extent of its dissemination in the countries of the different regions and information on this subject is currently limited," the WHO said.
The WHO is advising countries to increase laboratory and capacity to allow for early and reliable identification of hvKp strains, reinforce laboratory capacities for molecular testing and analysis, develop a surveillance system for the systematic collection of microbiologic and clinical data, and implement enhanced infection prevention and control measures in healthcare settings. The agency also said it will help countries strengthen clinical and public health awareness for the detection of hvKp strains and support development of a consensus definition of hvKp.
The World Health Organization (WHO) is warning countries about increasing reports of hypervirulent and multidrug-resistant Klebsiella pneumoniae (hvKp).
The warning is based on a global assessment the WHO conducted through its Global Antimicrobial Resistance and Surveillance System (GLASS), which issued a request for information earlier this year to all countries enrolled in the system after receiving reports of increased identification of hvKp isolates in several countries. Of the 43 countries and territories that responded to the WHO request, 16 reported the presence of hvKp strains.
In contrast to "classic" K pneumoniae, an opportunistic pathogen that is a leading cause of healthcare-associated infections and tends to cause infections in vulnerable, immunocompromised hospitalized patients, hvKp strains can cause severe invasive infections in healthy individuals that develop quickly and spread to various body sites. Infections caused by hvKp strains have been associated with high morbidity and mortality.
Although hvKp infections were initially found community settings in parts of Asia and were susceptible to antibiotics, recent reports have shown transmission of multidrug-resistant hvKp strains in healthcare settings in several countries.
Carbapenem-resistant hvKp strain raises concerns
The WHO is particularly concerned about one strain of hvKp, sequence type (ST)23, a strain that carries genes (carbapenemase genes) that confer resistance to carbapenem antibiotics and all available beta-lactam antibiotics. Experts say the combination of hypervirulence and carbapenem-resistance genes in K pneumoniae strains is worrisome.
"In general, carbapenem-resistant gram-negative bacteria are a major concern as the ability to treat them is severely constrained," Amesh Adalja, MD, FIDSA, a senior scholar at the Johns Hopkins University Center for Health Security, told CIDRAP News. "When you couple carbapenem-resistance with the hypervirulence exhibited by certain strains of K pneumoniae it is a recipe for increased morbidity and mortality from this bacterium."
In addition, the WHO noted that ST23 strains out-compete other gut bacteria, which can facilitate colonization and spread, and have the capacity to generate outbreaks. The WHO said in its assessment that with the concurrence of hypervirulence and antibiotic resistance, "it is expected that there will be an increased risk of spread of these strains at both the community and hospital levels."
Of the 16 countries that reported the presence of hvKp strains, 12 (Algeria, Argentina, Australia, Canada, India, Iran, Japan, Oman, Philippines, Switzerland, Thailand, and the United Kingdom) specifically reported the presence of the ST23-K1 strain. The United States is among the countries that reported the presence of hvKp strains.
When you couple carbapenem-resistance with the hypervirulence exhibited by certain strains of K pneumoniae it is a recipe for increased morbidity and mortality from this bacterium.
The WHO said the risk at the global level is moderate because there is currently no systematic surveillance for the routine identification, reporting, and monitoring of hvKp strains, and data on infections, hospitalizations, and the burden of disease are limited. Furthermore, many low-resource countries have limited diagnostic capacity and lack the molecular testing to identify virulence or resistance genes. And even in countries that have the ability to identify and analyze hvKp strains, the agency said, many physicians are unfamiliar with the clinical presentation of hvKp infections, and hvKp "may go unnoticed."
"The prevention and control of carbapenem-resistant hvKp poses significant challenges because it has not been possible to establish the extent of its dissemination in the countries of the different regions and information on this subject is currently limited," the WHO said.
The WHO is advising countries to increase laboratory and capacity to allow for early and reliable identification of hvKp strains, reinforce laboratory capacities for molecular testing and analysis, develop a surveillance system for the systematic collection of microbiologic and clinical data, and implement enhanced infection prevention and control measures in healthcare settings. The agency also said it will help countries strengthen clinical and public health awareness for the detection of hvKp strains and support development of a consensus definition of hvKp.