An extensive analysis of data belonging a large public healthcare system in New York City has uncovered disturbing trends concerning carbapenem-resistant Klebsiella pneumoniae (CRKP) infections from 2016 onwards. The findings, recently published in ‘Emerging Infectious Diseases’, highlighted a significant surge in CRKP infections during the COVID-19 pandemic, a higher count of infections originating in communities, and the emergence of new resistance mechanisms which pose a major challenge to first-line antibiotics.
The researchers employed data from the National Healthcare Safety Network to examine laboratory-identified CRKP infections within a hospital network comprising 11 acute care hospitals that provide services to more than 1.2 million people annually. Patient medical records were used to establish admissions sources, while examination of testing results from the New York State Department of Health helped determine antibiotic susceptibility and identify the enzymes responsible for carbapenem resistance.
CRKP and other members of the carbapenem-resistant Enterobacterales (CRE) family, as considered by the Centers for Disease Control and Prevention, pose an urgent public health threat. These infections often occur in healthcare settings, particularly among patients who are severely ill, have been on antibiotics, and are either on ventilators or have indwelling devices. They present a significant treatment challenge as carbapenem antibiotics are often the last line of defense for multidrug-resistant infections.
During the period of study – January 1, 2016, to June 30, 2022 – 509 patients with CRKP were identified. The main sources of these infections were the genitourinary tract, respiratory tract, bloodstream, and skin or other soft tissue. Over half of these patients’ infections were deemed community-onset, and despite CRKP cases declining from 2016 to 2020, the data revealed a noticeable increase in such infections in late 2021 and early 2022.
The rise might be reflective of the national surge observed in several healthcare-associated infections during the pandemic because of prolonged hospitalizations due to COVID, an uptick in antibiotic use, staff shortages, and diminished focus on standard infection prevention and control methods. The study recorded an unexpectedly large number of community-onset CRKP cases, suggesting a significant rise in infections originating from long-term care facilities.
The emergence of the New Delhi metallo-beta-lactamase (NDM) enzyme in carbapenem-resistant K. pneumoniae identified in the study is particularly worrisome. This is because NDM-producing strains are significantly more problematic, with resistance to ceftazidime-avibactam, a commonly used antibiotic for treating carbapenem-resistant infections. The reduction in effective treatment options intensifies the threat.
Given the increasing community-onset cases, the overall increase in numbers, and the emergence of NDM-possessing carbapenem-resistant K. pneumoniae, the study authors recommend aggressive and holistic surveillance and isolation measures involving both acute-care and long-term care facilities to stymie further pathogen spread.