CARBAPENEM-resistant Enterobacterales (CRE) infections are on the rise across the EU/EEA, with experts from the European Centre for Disease Prevention and Control (ECDC) warning of worsening transmission and increasing resistance. The continued spread of high-risk CRE lineages in hospitals, alongside emerging resistant species, poses a growing threat to patient safety and public health.
A new epidemiological assessment highlights an increase in carbapenem-resistant Klebsiella pneumoniae bloodstream infections in 23 EU countries. The study also reports a concerning trend of hypervirulent K. pneumoniae strains carrying resistance genes, alongside the emergence of resistant Escherichia coli with the potential for community spread. The plasmid-mediated transmission of carbapenemase genes is accelerating outbreaks within hospitals and healthcare networks, making containment increasingly difficult. With limited treatment options available, delays in effective therapy contribute to high mortality rates.
The probability of further CRE spread in the EU/EEA is now classified as high, with the impact ranging from moderate to severe depending on the effectiveness of control measures. Despite the availability of new antimicrobials, their limited accessibility and suboptimal infection prevention and control implementation have hindered efforts to curb transmission. Without urgent action, experts warn of a high-to-very-high risk of sustained outbreaks.
To combat the growing threat, public health agencies are calling for enhanced national coordination of control measures between hospitals and regions. This includes the development of dedicated CRE management plans with clear targets, sufficient funding, and regular public progress reports. Hospitals are urged to implement stricter IPC measures, including pre-emptive isolation and screening of patients who have been hospitalised in regions with high CRE prevalence.
Strengthening antimicrobial stewardship is also crucial, with national treatment guidelines needed to ensure the judicious use of available therapies. Expanded genomic surveillance, including real-time whole-genome sequencing, is recommended to identify transmission chains and detect emerging resistant strains early. Furthermore, investment in laboratory capacity is essential for rapid CRE detection and characterisation, enabling targeted treatment strategies. Experts also stress the need for increased innovation and access to new antimicrobials to counter the growing resistance crisis.
With CRE infections posing a significant public health burden across Europe, urgent and coordinated action is needed to slow the spread, protect vulnerable patients, and safeguard the future of antibiotic therapy.
Ada Enesco, EMJ
Reference
European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment – Carbapenem-resistant Enterobacterales – third update. 2025. Available at: https://www.ecdc.europa.eu/en/publications-data/carbapenem-resistant-enterobacterales-rapid-risk-assessment-third-update. Last accessed: 10 February 2025.
