ECDC warns about the spread of last-line antibiotic-resistant bacteria in European hospitals
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The largest European genomic study on carbapenem-resistant and/or colistin-resistant Enterobacterales shows alarming signals for Klebsiella pneumoniae and Escherichia coli. The data comes from over 300 hospitals in 36 countries and indicates the need for stronger genomic surveillance.
The European Centre for Disease Prevention and Control announces that a genomic study conducted in over 300 hospitals in 36 countries indicates alarming signals regarding the spread of last-resort antibiotic-resistant bacteria.
In brief
The study is the largest European genomic investigation conducted so far on carbapenem-resistant and/or colistin-resistant Enterobacterales.
The data was collected in 2019 from over 300 hospitals in 36 countries.
For Klebsiella pneumoniae, the study shows the continued circulation of high-risk lineages and the emergence of concerning developments.
For Escherichia coli, ECDC signals the risk that carbapenem-resistant forms may become endemic in Europe if new public health measures are not implemented.
The data collection for the third European study on carbapenem-resistant Enterobacterales, CRE25, is ongoing.
The European Centre for Disease Prevention and Control has announced the publication of the results of the largest European genomic study conducted so far on carbapenem-resistant and/or colistin-resistant Enterobacterales, CCRE.
The study provides the most comprehensive genomic picture available so far on these bacteria in hospitals across Europe.
Carbapenem-resistant Enterobacterales are considered critical priority pathogens because they can cause hard-to-treat infections, with limited therapeutic options and insufficient development of new antibiotics.
The results of the study were published in the journal Lancet Microbe, through separate articles on Klebsiella pneumoniae and Escherichia coli, and in a detailed ECDC report.
The study was coordinated by ECDC, in collaboration with the Public Health Agency of Sweden and the Centre for Genomic Pathogen Surveillance at the Pandemic Sciences Institute of the University of Oxford.
The investigation included epidemiological, microbiological data, and data obtained through whole-genome sequencing, collected in 2019 from over 300 hospitals in 36 countries.
ECDC describes the study as the second major structured European genomic surveillance exercise after the European Survey of Carbapenemase-producing Enterobacteriaceae, EuSCAPE, conducted in 2013-2014.
The new study marks the transition from previous epidemiological assessments to integrated genomic surveillance at the European level.
The initiative was not limited to data collection. Participating countries underwent capacity assessments, training, and external quality assurance exercises to support the implementation of genomic methods in national reference laboratories.
ECDC states that this coordinated effort has allowed many European countries to advance towards routine genomic surveillance of antimicrobial resistance.
The capacity of participating national reference laboratories in the EURGen-Net network has also been supported by broader initiatives from the European Commission, including the HERA Incubator, the EURGen-RefLabCap project, support through the EU4Health program, and the ECDC GenEpi-BioTrain training program.
For Klebsiella pneumoniae, the CCRE study shows that high-risk carbapenem-resistant lineages, already identified during EuSCAPE, continue to circulate in European hospitals.
ECDC also signals concerning changes for Klebsiella pneumoniae, including more frequent acquisition of carbapenemase genes by high-risk lineages, the emergence of new high-risk lineages, and increased spread of isolates carrying virulence genes.
For Escherichia coli, the study indicates several warning signals regarding the worsening epidemiological situation in Europe.
These signals include more frequent acquisition of carbapenemase genes by high-risk sequence types and greater clonal spread of multidrug-resistant lineages.
An important finding is the increased detection of Escherichia coli isolates carrying the NDM-5 carbapenemase gene.
ECDC states that these results suggest a high risk that carbapenem-resistant Escherichia coli may become endemic in Europe if additional public health measures are not implemented.
Taken together, the results show heterogeneous but increasingly concerning epidemiological patterns. The situation varies between countries, from sporadic cases to endemic circulation.
ECDC emphasizes that genomic data are essential for tracking the spread of antimicrobial resistance in Europe.
The study also provides baseline data for future research on carbapenem-resistant Klebsiella pneumoniae and Escherichia coli.
The data collection for the third European study on carbapenem-resistant Enterobacterales, CRE25, is ongoing.
CRE25 uses a simplified sampling protocol and rapid reporting, supported by enhanced whole-genome sequencing capacity in national reference laboratories.
Antimicrobial resistance is one of the main threats to public health, as it reduces the effectiveness of existing treatments and can turn treatable infections into infections with limited options.
Carbapenems are antibiotics commonly used as last-resort options for severe bacterial infections. Colistin is also used in situations where other treatments are no longer effective.
Enterobacterales include bacteria such as Klebsiella pneumoniae and Escherichia coli. Some strains can acquire resistance genes that make them hard to treat and that can spread between hospitals, patients, and countries.
Genomic surveillance allows for detailed identification of bacterial lineages, resistance genes, and transmission patterns. For health authorities, this information can support faster and better-targeted responses.
Through EURGen-Net and European support programs for national laboratories, ECDC aims to strengthen the capacity of states to detect and monitor antibiotic-resistant bacteria in a comparable manner at the European level.
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