As healthcare providers, our ability to fight infections today is beset by certain challenges. Among them, Klebsiella pneumoniae Carbapenemase Producing (KPC-KP) infections present a persistent obstacle to public health. This ten-year prospective study aims to analyze the trends, clinical features, and genomic epidemiology of KPC-KP infections in both hospital-onset and non-hospital-onset environments.
Our focus is also on the impacts of an antimicrobial stewardship program (ASP) rolled out in 2014, and the Infection Prevention and Control (IPC) measures put in place during the COVID-19 pandemic, particularly in terms of their effect on hospital-to-community transmission dynamics.
Between 2012 and 2022, our study followed patients in a tertiary referral hospital, tracking the shifts in incidence density of these infections, while analyzing the temporal associations between hospital and non-hospital onset infection trends. Patient clinical outcomes were examined within a multivariable regression framework.
Our findings show that following the ASP implementation, the incidence density of both types of infections displayed a significant decline. This success was maintained throughout the COVID-19 pandemic. Genomic data also highlighted the pivotal role of temporal dynamics in disease dissemination.
Further investigation underscored the need for system-wide surveillance and control strategies targeted at non-hospital-onset infections, in addition to those for hospital-onset infections. Such measures are crucial, given the rising incidence of antibiotic-resistant infections, driven by the emergent genomic lineages of carbapenemase-producing Enterobacterales and the increased use of broad-spectrum antibiotics.
The study also revealed that the primary ST512/KPC-3 lineage was predominant, supporting the speculation of hospital-to-community spread. Interestingly, temporal factors, rather than type of acquisition, explained the observed genetic variation.
In conclusion, our study accents the vital role of ASP and COVID-19 IPC measures in maintaining low KPC-KP incidence. To enhance their effectiveness, they must be complemented by targeted, system-wide surveillance and control strategies, particularly in light of the looming threat of antimicrobial resistance.
Source: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-025-01614-6