Carbapenemase-producing (OXA-48) Klebsiella pneumoniae ST392 in travellers previously hospitalised in Gran Canaria, Spain

risk assessment
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European Centre for Disease Prevention and Control. Carbapenemase-producing (OXA-48) Klebsiella pneumoniae ST392 in travellers previously hospitalised in Gran Canaria, Spain – 10 July 2018, Stockholm, 2018

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This rapid risk assessment evaluates the risk of transmission and further spread of OXA-48-producing Klebsiella pneumonia e ST392 from travellers having sought medical care in Gran Canaria to healthcare facilities in their country of origin in the EU/EEA.

Executive summary

Between January and April 2018, Sweden and Norway reported a cluster of returning travellers who carried or were infected with carbapenemase (OXA-48)-producing Klebsiella pneumoniae ST392. All cases were associated with hospital admissions in Gran Canaria. Isolates from cases showed tight clustering when analysed by whole genome sequencing.  

This cluster of 13 patients colonised or infected with OXA-48-producing K. pneumoniae ST392 is an example of cross-border spread of carbapenemase-producing Enterobacteriaceae (CPE) in the European Union/European Economic Area (EU/EEA). Cross-border transfers of patients or hospital admissions of patients with previous hospitalisation in another country are a daily occurrence in EU/EEA hospitals.  

The risk for individual travellers to acquire OXA-48-producing K. pneumoniae ST392 of the Gran Canaria cluster without healthcare contact is very low. However, if carriers of OXA-48-producing K. pneumoniae ST392 of the Gran Canaria cluster are admitted to a hospital in their country of origin, there is a high risk of transmission and subsequent outbreaks if OXA-48-producing K. pneumoniae ST392 carriage remains undetected and there are no adequate infection control and prevention measures.

This example highlights the benefits of active surveillance (screening) for CPE carriage, including OXA-48producing K. pneumoniae ST392, immediately at hospital admission in patients who are directly transferred from a hospital abroad. It also shows the value of cross-country sharing of epidemiological and whole genome sequencing data as well as the added value of collaborative analyses to determine the origin of this OXA-48producing K. pneumoniae ST392 cluster. 

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