ANTIMICROBIAL RESISTANCE IN KLEBSIELLA PNEUMONIAE AT THE HUMAN–ANIMAL–ENVIRONMENT INTERFACE: A ONE HEALTH REVIEW

Abstract

Klebsiella pneumoniae is an ubiquitous opportunistic pathogen, and has become a high priority pathogen on the World Health Organization (WHO) bacterial priority pathogens list, mainly because of the quick dissemination of multidrug-resistant (MDR) and hypervirulent strains all over the world. This review covers the epidemiology, transmission patterns and molecular mechanisms of antimicrobial resistance (AMR) in K. pneumoniae in humans, animals and the environment from a One Health perspective. We consolidate knowledge from genomic surveillance studies, showing that there is a significant overlap between human and non-human K. pneumoniae populations, and that high-risk sequence types like ST11 and ST258 are present in a variety of hosts. Hypervirulence in lineages such as ST23-KL57 is a growing threat to public health because it is now combined with resistance to the carbapenems. Mobile genetic elements such as plasmids are the main agents of horizontal transmission of resistance and virulence. Wastewater facilities and agriculture are important environmental reservoirs that facilitate the spread of AMR. We emphasize the advances in diagnostics, prevention and the critical importance of establishing genomic surveillance networks that support evidence-based response to this pathogen's complex threat.