改变克雷伯肺炎杆菌和大肠埃希菌中碳青霉烯酶的分布：CRE25调查主要收集的初步结果

Changing carbapenemase distribution inKlebsiellapneumoniaeandEscherichia coliin the EU/EEA–preliminaryresults from themain collection of theCRE25 survey June 2026 Preliminary datafromthemain collectionof thesurvey of carbapenem-resistant Enterobacterales 2025(CRE25survey)indicatesa considerable change in the carbapenemasegenedistributionin carbapenem-resistant or carbapenem-susceptible, increased exposure (carbapenem-R/I)Klebsiella pneumoniaespeciescomplex (SC). It showeda decrease of the proportion ofblaKPCand an increasein the proportionofblaNDMcarbapenemasegenesin comparison to the surveyof carbapenem-and/or colistin-resistant Enterobacterales(CCRE survey)from 2019. The increaseintheproportionof isolates withblaNDMisdriven bythespread ofpreviously circulatingK.pneumoniaehigh-risk lineages(e.g.sequence type (ST)147)carryingblaNDM, theemergence of newblaNDM-positivehigh-risk lineages(e.g. ST383, ST395, ST6260)andtheacquisition ofblaNDMby lineages(e.g.ST258/512)previously associated with other carbapenemasegenes. Alongsideongoing dissemination ofblaNDM-1, a pronounced increase ofblaNDM-5has been observed. The risingproportion of isolates carryingblaNDMvariants is of high concern asmanynewer antimicrobials developed fortreatingcarbapenem-resistant Enterobacterales (CRE)infections, such as ceftazidime-avibactam,meropenem-vaborbactamand imipenem-relebactam, are not active against NDM-producingCRE. For the carbapenem-R/IEscherichiacolidataset, comparison of the results between surveys is more difficultdue to the low number of carbapenem-R/IE.coliisolates in thepreviousCCRE survey. In contrast toK.pneumoniaeSC, there is mainly an increase inthe proportion of theblaOXA-48-like carbapenemasegenesprimarily caused by increased detection ofblaOXA-244inE.coliisolates of extraintestinal pathogenic high-risklineages(e.g.ST38, ST131,ST13730, ST69,ST10)which are known to spread inthecommunityas well asinhealthcaresettings.The increasein the proportionofE.coliisolates carryingblaOXA-244is of concern due tothe potentialforundetectedtransmissionof these isolatesincommunity settings. Enhancedeffortsarerequiredto control and reduce harm related to the spread ofcarbapenemase-producingEnterobacterales (CPE)in the European Union/European Economic Area.These efforts shouldinclude: •improvingnational coordination and supportto hospitals for implementingcontrol measures;•developingnationalCPEmanagement plans;•implementingenhancedinfection prevention and controlmeasures and antimicrobial stewardshipprogrammes;•strengthening laboratory capacity for rapid detection and characterisation ofCPE,includinggenomicsurveillance;•strengtheninginnovation and access to antimicrobials indicated against CPE infections. Suggested citation: European Centre for Disease Prevention and Control. Changing carbapenemase distribution inKlebsiellapneumoniaeandEscherichia coliin the EU/EEA–preliminary results from the main collection of the CRE25 survey–June2026.Stockholm, June2026 ISBN978-92-9498-902-4doi:10.2900/2505127Catalogue numberTQ-01-26-047-EN-N© European Centre for Disease Prevention and Control, 2026. Reproduction is authorised, provided the source isacknowledged. Epidemiological situation Distribution of carbapenemasegenesinKlebsiellapneumoniaespecies complex In thepreliminary datasetfromthe survey of carbapenem-resistant Enterobacterales 2025(CRE25 survey),whichincludeddata from 21 countriesas of22 April 2026(Table 1),569(50%)of1139carbapenem-resistantor carbapenem-susceptible, increased exposure (carbapenem-R/I)Klebsiellapneumoniaespecies complex (SC)isolatescarriedblaNDM(alone or in combinationwith other carbapenemase genes)comparedto only177(20%)of900 isolatesin thesurveyof carbapenem-and/or colistin-resistant Enterobacterales(CCRE survey)in 2019. Incontrast, carbapenem-R/Iisolates carryingblaKPChavedecreased from448(50%)in the CCRE survey to281(25%)in the CRE25 survey1(Figure1and Table2). Among569CRE25 survey carbapenem-R/IK.pneumoniaeSC isolatescarryingblaNDMvariants,blaNDM-1, alone orin combination with other carbapenemase genes,wasthevariant detectedmost frequentlyin285isolates(50%),followed byblaNDM-5in260isolates(46%)2. These proportions changed compared to the CCRE survey,whereblaNDM-1was detected in160(90%)of177isolatescarryingblaNDMandblaNDM-5inonlynine(5%)isolates. The increase of carbapenem-R/IK.pneumoniaeSC isolates carryingblaNDM-5was associatedwiththeincreasingspread oftheknown high-risksequence type (ST)147 and emerging ST383, ST395, and ST6260K.pneumoniaelineages.In addition, several isolates(25, 4%)of thehigh-risk lineage ST258/512,previouslymainly associatedwithblaKPC,arenow carryingblaNDMvariantsin theCRE25 survey.The rising proportion of isolates carryingblaNDMvariants is of high concern asmanynewerbeta-lactam/beta-lactam inhibitorantimicrobials developed fortreatment of CRE,e.g.ceftazidime-avibactam,meropenem-vaborbactamand imipenem-relebactam,are notactive against NDM-producing Enterobacterales.This leaves ver