HQ Team
August 4, 2024: The WHO has warned about the rising global incidence of hypervirulent and multi-resistant Klebsiella Pneumoniae (hvKp) infections.
The hvKp pathogen is an organism or agent that can cause disease in a host, such as a human. Pathogens can be microorganisms, like bacteria, viruses, fungi, protozoa, or other organisms, like parasites, worms, or infectious proteins called prions.
Early this year the Global Antimicrobial Resistance and Surveillance System on Emerging Antimicrobial Resistance Reporting issued a request for information to the Global Antimicrobial Resistance and Surveillance System Antimicrobial Resistance National Focal points.
The purpose was to rapidly assess the current global situation after the increased identification of isolates of Klebsiella pneumoniae sequence type 23 carrying resistant genes to the carbapenem antibiotics – carbapenemase genes – reported in several countries.
A total of 43 out of 124 countries, territories, and areas across the six WHO Regions responded.
ST23-K1 strain
From these, a total of 16 countries and territories reported the presence of hvKp and 12 reported specifically the presence of the strain ST23-K1, according to a WHO statement.
“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, was quoted as saying by the Center for Infectious Disease Research and Policy, a centre within the University of Minnesota.
“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.”
At a global level, the infections caused by hvKp traditionally have occurred within communities in certain geographical regions, such as Asia, and are associated with high morbidity and mortality as well as high pathogenicity and limited antibiotic choices, according to the WHO.
Recent reports from the WHO European region and the European Centre for Disease Prevention and Control have shown transmission in healthcare settings, and several studies from China have reported clusters of healthcare-associated infections of hvKp.
Movement of people
The WHO emphasises the importance of strict infection prevention and control measures when managing these cases in healthcare settings. “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.
“As with other resistance mechanisms, the risk of spread could increase due to high movements of people within and between countries and regions.”
Many low-resource countries have limited diagnostic capacity and lack the molecular testing to identify virulence or resistance genes, according to the WHO.
And even in countries that can identify and analyze hvKp strains, the agency said, many physicians are unfamiliar with the clinical presentation of hvKp infections, and hvKp “may go unnoticed.”
It may “already” be a serious problem in the WHO African region.
“In the WHO African region, cases of hvKp might be present but the extent of the problem is not yet known. Detection of hvKp ST23 carrying carbapenem resistance genes or any other virulence or resistance marker requires the use of molecular methods which may not be routinely monitored in many microbiology laboratories across the region.”
Moderate risk
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 is limited.
Even with appropriate antibiotic treatment, the mortality rate of hospital-acquired pneumonia is still more than 50%. The incidence rate and mortality of diseases caused by hvKp are very high, especially for newborns, leukaemia patients, and other immunodeficiency patients.
With the growing use of antibiotics, multidrug-resistant hvKp has become more common, posing greater difficulties and obstacles in clinical treatment.
The hvKp is found in the environment, including soil, surface water, and medical devices, on mammalian mucous membranes and in humans, it colonizes the upper part of the throat (nasopharynx) and gastrointestinal tract.
The pathogen is a leading cause of infections acquired in healthcare institutions globally and has been considered an opportunistic pathogen, as it typically causes infections in hospitalized or immunocompromised individuals.
A large percentage of infections occur in newborns, the elderly, and those with compromised immune systems. It can infect the respiratory tract, the urinary tract, as well as wounds or soft tissues.
Colonisation, spread
The WHO stated that ST23 strains out-compete other gut bacteria, which can facilitate colonisation 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.”
The WHO advised countries to increase laboratory capacity to allow for early and reliable identification of hvKp strains and reinforce laboratory capacities for molecular testing and analysis.
It urged nations to 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 the development of a consensus definition of hvKp.
