Whole genome sequencing shows tight clustering between bacterial isolates in returning travelers

Thirteen patients with OXA-48-producing Klebsiella pneumoniae ST392 have been reported by Sweden and Norway between January and April 2018 - all returning travelers with prior hospital admission in Gran Canaria, Spain. Whole genome sequencing showed tight clustering between the bacterial isolates from the cases.

According to ECDC's risk assessment published today, the risk for individual travelers to acquire OXA-48-producing K. pneumoniae ST392 of the Gran Canaria cluster without healthcare contact is very low.

However, if carriers of the bacteria are admitted to a hospital in their country of origin, there is a high risk for further transmission and outbreaks if carriage is not detected and if adequate infection prevention and control measures are not in place.

Whole genome sequencing analysis indicates a common place of acquisition for the cases. Given the large number of tourists visiting Gran Canaria, one hospital may become the source of spread to other European countries when patients are transferred from one country to another, making this cluster a cross-border threat, states the report.

In 2016, more than 15 million citizens from the European Union and European Economic Area (EU/EEA), mainly from Spain, the UK and Germany, traveled to the Canary Islands according to International Air Transport Association.

OXA-48-producing K. pneumoniae is a resistant bacterium typically acquired in healthcare settings. Hospitalization abroad and cross-border transfer of patients are well known modes of introduction of carbapenemase-producing Enterobacteriaceae (CPE), including OXA-48-producing K. pneumoniae ST392, into countries with lower prevalence.

The report suggests that hospitals in EU/EEA countries should consider taking, at hospital admission, a detailed history of all travels and hospitalizations of the patient.

All patients who are directly transferred or were hospitalized in a foreign country 12 months prior to hospital admission may be considered for screening, regardless of the CPE prevalence at place of hospitalization.

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