The evolution of carbapenem-resistant Klebsiella pneumoniae in Greek intensive care units is driven by local carbapenemase acquisition, nationwide nosocomial spread and emerging resistance to novel antimicrobials
In brief
More than 88% of Greek ICU Klebsiella isolates linked to spread clusters
Among 271 drug-resistant Klebsiella isolates from 17 Greek intensive care units, more than 88% were linked to transmission clusters spanning one to eight units. Aztreonam-avibactam and cefepime-zidebactam remained active against most isolates, but resistance was more common in bacteria carrying multiple carbapenemases, and emerging resistance plus diagnostic gaps complicate treatment and tracking.
- Journal
- The Journal of infection (Q1)
- Published
- 5 November 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Ioannis Baltas, Georgia Vrioni, Omar A Romero-Rodriguez, Benjamin Sobkowiak, Sofia Vourli, Jose L Perez-Martinez, et al.
- PMID
- 42988224
- DOI
- 10.1016/j.jinf.2026.106891
Why clinicians should know about it
- Picked for Microbiology (medical) (paper of the day, 7 November 2026): Carbapenemase, susceptibility, and genomic transmission surveillance in ICU isolates
Abstract
OBJECTIVES: We investigated transmission patterns and therapeutic options for Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) in Greek ICUs. METHODS: CR-Kp isolates (N=271) were prospectively collected from patients in 17 Greek ICUs between 2021-2023 (INCREASE study, funded by Pfizer). Susceptibility profiles were determined by broth microdilution and genomes sequenced with Oxford Nanopore. RESULTS: All isolates produced carbapenemases: 48% KPC, 20% NDM, 4.4% VIM, 27.6% multi-carbapenemase producers. Resistance to carbapenems, fluoroquinolones, aminoglycosides, and co-trimoxazole exceeded 90%, except for amikacin (73.4%) and colistin (46.5%). Aztreonam-avibactam and cefepime-zidebactam showed the highest susceptibility, 94.5% and 91.6% respectively, yet resistance was >10% among multi-carbapenemase producers. High levels of resistance to cefiderocol (41.7%) and cefepime-taniborbactam (21.4%) were detected. Aztreonam-avibactam resistance co-occurred with VEB-25 and a novel VEB variant. Predominant sequence types included ST39 (28.1%), ST11 (22.7%), and ST258 (18.4%). Time-scaled phylogenies demonstrated that following CG importation CR-Kp often acquired multiple carbapenemases. Over 88% of isolates were implicated in transmission clusters involving 1-8 ICUs across the country. CONCLUSIONS: In Greek ICUs, CR-Kp appears to emerge via local plasmid acquisition and then spread within and between hospitals. While aztreonam-avibactam and cefepime-zidebactam remain promising treatment options, resistance among multi-carbapenemase producers and diagnostic gaps (notably for VEB variants) are concerning.
Abstract as published, via PubMed.
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