BackgroundAfter most COVID-19 pandemic control measures were lifted in 2022, many infectious diseases re-emerged. An increase in invasive group A streptococcal (iGAS) infections among adults and young children was reported by several countries. Viral infections including influenza and varicella, known risk factors for iGAS infection, also increased. AimTo estimate the proportion of GAS skin and soft tissue infections (SSTI) and pneumonia/sepsis in children (≤ 5 years) attributable to varicella, and the proportion of GAS pneumonia/sepsis in children and adults attributable to potentially predisposing respiratory viruses influenza A and B, RSV, hMPV and SARS-CoV-2 in the Netherlands. MethodsWe performed time series regression using weekly data on respiratory viruses, varicella and non-invasive GAS infections and GAS isolates cultured from blood, lower airways, skin, pus and wounds, from January 2010 to March 2023. ResultsIn 2010–19, 50% (95% CI: 36–64) of GAS SSTI in children were attributable to varicella. Between January 2022 and March 2023, 34% (95% CI: 24–43) of GAS SSTI cases were attributable to varicella. Of iGAS pneumonia/sepsis between January 2022 and March 2023, 34% (95% CI: 20–49) and 25% (95% CI: 18–32) was attributable to respiratory virus infections in children and adults, respectively, with the largest contributor (17%) being influenza A. ConclusionsPredisposing viral infections likely contributed to, but cannot fully explain, the observed iGAS increase among children and adults in 2022–23 in the Netherlands. Public health measures to control viral infections, such as vaccination against varicella or influenza, might reduce the iGAS disease burden. …

Since November 2023, the absolute number of attendances at emergency departments for pneumonia among children aged 5–14 years in England have been above expected levels for the time of year. This increased signal peaked during March 2024 but then persisted into early summer 2024 despite decreases in prevalence of seasonal respiratory pathogens. Record linkage between emergency department and laboratory databases points to this unusual activity being driven largely by Mycoplasma pneumoniae. …

Specific antipsychotics prescribed in high doses were linked to an increased risk for pneumonia in patients with schizophrenia, new research showed. Medscape Medical News…

Researchers examined time to clinical stability in 571 children hospitalized with community-acquired pneumonia. Medscape Medical News…

In 2023, an increase of OXA-48-producing Klebsiella pneumoniae was noticed by the Lithuanian National Public Health Surveillance Laboratory. Whole genome sequencing (WGS) of 106 OXA-48-producing K. pneumoniae isolates revealed three distinct clusters of carbapenemase-producing K. pneumoniae high-risk clones, including sequence type (ST) 45 (n = 35 isolates), ST392 (n = 32) and ST395 (n = 28), involving six, six and nine hospitals in different regions, respectively. These results enabled targeted investigation and control, and underscore the value of national WGS-based surveillance for antimicrobial resistance. …

BackgroundCarbapenemase-producing Enterobacterales are a public health threat worldwide and OXA-48 is the most prevalent carbapenemase in Germany and western Europe. However, the molecular epidemiology of OXA-48 in species other than Escherichia coli and Klebsiella pneumoniae remains poorly understood. AimTo analyse the molecular epidemiology of OXA-48 and OXA-48-like carbapenemases in Citrobacter species (spp.) in Germany between 2011 and 2022. MethodsData of 26,822 Enterobacterales isolates sent to the National Reference Centre (NRC) for Gram-negative bacteria were evaluated. Ninety-one Citrobacter isolates from 40 German hospitals harbouring blaOXA-48/OXA-48‑like were analysed by whole genome sequencing and conjugation experiments. ResultsThe frequency of OXA-48 in Citrobacter freundii (CF) has increased steadily since 2011 and is now the most prevalent carbapenemase in this species in Germany. Among 91 in-depth analysed Citrobacter spp. isolates, CF (n = 73) and C. koseri (n = 8) were the most common species and OXA-48 was the most common variant (n = 77), followed by OXA-162 (n = 11) and OXA‑181 (n = 3). Forty percent of the isolates belonged to only two sequence types (ST19 and ST22), while most other STs were singletons. The plasmids harbouring blaOXA‑48 and blaOXA-162 belonged to the plasmid types IncL (n = 85) or IncF (n = 3), and plasmids harbouring blaOXA‑181 to IncX3 (n = 3). Three IncL plasmid clusters (57/85 IncL plasmids) were identified, which were highly transferable in contrast to sporadic plasmids. ConclusionIn CF in Germany, OXA-48 is the predominant carbapenemase. Dissemination is likely due to distinct highly transmissible plasmids harbouring blaOXA‑48 or blaOXA-48-like and the spread of the high-risk clonal lineages ST19 and ST22. …

We report on an ongoing measles outbreak in the Federation of Bosnia and Herzegovina with 141 cases notified between week 52 2023 and week 6 2024. Among those with known vaccination status, 97% were unvaccinated and the most affected group is children under the age of 5 years (n = 87) who were not vaccinated during the pandemic years. Sixty-eight cases were hospitalised, the most common complications were measles-related pneumonia and diarrhoea. The sequenced measles viruses from four cases belonged to genotype D8. …

This report describes an increase in Mycoplasma pneumoniae, a common cause of respiratory illness, beginning in fall 2023.

The ECDC has called for mitigating actions in the face of more European Union and European Economic Area countries reporting hypervirulent Klebsiella pneumoniae ST23. Medscape Medical News…

Exblifep is as effective as piperacillin-tazobactam in the treatment of complicated urinary tract infections, the European Medicines Agency said. Medscape Medical News…

Mycoplasma pneumoniae is an important cause of pneumonia and extra-pulmonary manifestations. We observed a rise in admissions due to M. pneumoniae infections starting October 2023 in a regional hospital in the Netherlands and an increased incidence in national surveillance data. The incidence in the Netherlands has not been that high since 2011. The patients had a lower median age compared with 2019 and 2020 (28 vs 40 years). M. pneumoniae should be considered in patients with respiratory symptoms, especially children. …

Daily toothbrushing was associated with a 33% reduction in risk for hospital-acquired pneumonia among inpatients, according to a recent analysis. Medscape Medical News…

In 2023, through an ongoing respiratory pathogen surveillance system, we observed from mid-September onwards, an increase of respiratory illness among children aged ≤ 15 years presenting at hospital outpatient clinics in Beijing, China. Data indicated that illness was caused by multiple pathogens, predominantly Mycoplasma pneumoniae. Seasonality, periodicity and high prevalence of resistance to macrolide (30 of 30 strains sequenced with the A2063G mutation) were important characteristics of the M. pneumoniae epidemic, which resulted in a rise in consultations at specialised paediatric hospitals. …

We report a surge of patients, especially children and adolescents, with respiratory disease caused by Mycoplasma pneumoniae in Denmark since October 2023. While the surge has reached an epidemic level, no impact on hospital capacity has been observed; only 14% (446/3,195) of cases, primarily adults, required hospitalisation. Macrolide resistance was detected in less than 2% of samples tested. Timely monitoring of hospitalisations linked to M. pneumoniae infections has been established to inform the healthcare system, decisionmakers and the public. …

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 3-9 December 2023 and includes updates on respiratory virus epidemiology in the EU/EEA, SARS-CoV-2 variant classification, measles, mpox, Mycoplasma pneumoniae, West Nile virus, and MERS-CoV.

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 3-9 December 2023 and includes updates on respiratory virus epidemiology in the EU/EEA, SARS-CoV-2 variant classification, measles, mpox, Mycoplasma pneumoniae, West Nile virus, and MERS-CoV.

A rise in respiratory illnesses in China and clusters of pneumonia in children and resistance to a common antibiotic have specialists taking a closer look at important trends. Medscape Medical News…

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 19 - 25 November 2023 and includes updates on human infection with influenza A(H1N2)v, influenza A(H5N1), an overview of respiratory virus epidemiology in the EU/EEA, respiratory infections due to Mycoplasma pneumoniae in the EU/EEA, HIV/AIDS surveillance 2023 (2022 data), West Nile virus, SARS-CoV-2 variant classification, and poliomyelitis.

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 19 - 25 November 2023 and includes updates on human infection with influenza A(H1N2)v, influenza A(H5N1), an overview of respiratory virus epidemiology in the EU/EEA, respiratory infections due to Mycoplasma pneumoniae in the EU/EEA, HIV/AIDS surveillance 2023 (2022 data), West Nile virus, SARS-CoV-2 variant classification, and poliomyelitis.

Der har siden sommeren været en stigning i antallet af luftvejsinfektioner med Mycoplasma pneumoniae, og forekomsten har nu nået et epidemisk niveau med væsentlig flere tilfælde end normalt.

BackgroundPreliminary unpublished results of the survey of carbapenem- and/or colistin-resistant Enterobacterales (CCRE survey) showed the expansion of carbapenemase-producing Klebsiella pneumoniae (CPKP) sequence type (ST) 39 in 12 of 15 participating Greek hospitals in 2019. AimWe conducted a rapid survey to determine the extent of spread of CPKP high-risk clones in Greek hospitals in 2022 and compare the distribution of circulating CPKP clones in these hospitals since 2013. MethodsWe analysed whole genome sequences and epidemiological data of 310 K. pneumoniae isolates that were carbapenem-resistant or ‘susceptible, increased exposure’ from Greek hospitals that participated in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE, 2013–2014), in the CCRE survey (2019) and in a national follow-up survey (2022) including, for the latter, an estimation of transmission events. ResultsFive K. pneumoniae STs including ST258/512 (n = 101 isolates), ST11 (n = 93), ST39 (n = 56), ST147 (n = 21) and ST323 (n = 13) accounted for more than 90% of CPKP isolates in the dataset. While ST11, ST147 and ST258/512 have been detected in participating hospitals since 2013 and 2014, KPC-2-producing ST39 and ST323 emerged in 2019 and 2022, respectively. Based on the defined genetic relatedness cut-off, 44 within-hospital transmission events were identified in the 2022 survey dataset, with 12 of 15 participating hospitals having at least one within-hospital transmission event. ConclusionThe recent emergence and rapid spread of new high-risk K. pneumoniae clones in the Greek healthcare system related to within-hospital transmission is of concern and highlights the need for molecular surveillance and enhanced infection prevention and control measures. …

BackgroundSince 2021, an emergence of New Delhi metallo-β-lactamase (NDM)-14-producing Klebsiella pneumoniae has been identified in France. This variant with increased carbapenemase activity was not previously detected in Enterobacterales. AimWe investigated the rapid dissemination of NDM-14 producers among patients in hospitals in France. MethodsAll NDM-14-producing non-duplicate clinical isolates identified in France until June 2022 (n = 37) were analysed by whole genome sequencing. The phylogeny of NDM-14-producers among all K. pneumoniae sequence type (ST) 147 reported in France since 2014 (n = 431) was performed. Antimicrobial susceptibility testing, conjugation experiments, clonal relationship and molecular clock analysis were performed. ResultsThe 37 NDM-14 producers recovered in France until 2022 belonged to K. pneumoniae ST147. The dissemination of NDM-14-producing K. pneumoniae was linked to a single clone, likely imported from Morocco and responsible for several outbreaks in France. The gene blaNDM-14 was harboured on a 54 kilobase non-conjugative IncFIB plasmid that shared high homology with a known blaNDM-1-carrying plasmid. Using Bayesian analysis, we estimated that the NDM-14-producing K. pneumoniae ST147 clone appeared in 2020. The evolutionary rate of this clone was estimated to 5.61 single nucleotide polymorphisms per genome per year. The NDM-14 producers were highly resistant to all antimicrobials tested except to colistin, cefiderocol (minimum inhibitory concentration 2 mg/L) and the combination of aztreonam/avibactam. ConclusionHighly resistant NDM-14 producing K. pneumoniae can rapidly spread in healthcare settings. Surveillance and thorough investigations of hospital outbreaks are critical to evaluate and limit the dissemination of this clone. …

New Delhi metallo-beta-lactamase (NDM)-producing Klebsiella pneumoniae (Kp) ST147 caused a large multi-hospital outbreak in Italy from 2018 to 2021. We describe a new ST6668 NDM-producing Kp clone, belonging to CC147, which rapidly spread across hospitals in the Pavia province (Northern Italy) from February to August 2023. Genomic analyses revealed that ST6668 is different from ST147 and fast evolving. As shown here, genomic surveillance programmes are useful for tracking the spread of new clones with reduced susceptibility to most antibiotics. …

New research from Northwestern University and the University of Wisconsin, however, is pointing to bacterial pneumonia as the cause of many severe COVID deaths. WebMD Health News…

A 64-year-old woman diagnosed with pneumonia had abdominal pain, diarrhea, dry cough, and night sweats. A year of inexplicable symptoms ended in an open biopsy and a live, stringlike worm. Medscape Medical News…

Clinicians should consider all three etiologies on community-acquired pneumonia presentation to improve antimicrobial stewardship and patient outcomes. CDC Expert Commentary…