The Norwegian Klebsiella pneumoniae network: K. pneumoniae population structure and antimicrobial resistance in a One Health perspective

Antimicrobial resistance (AMR) is a threat to the global public health. Klebsiella pneumoniae has emerged as a high-risk pathogen in humans due to the increasing levels of antibiotic resistance to our most used antibiotics, and the bacterias ability to cause severe disease, especially in severe ill and immunocompromised patients. Infections caused by multidrug resistant K. pneumoniae may be very challenging, and in some cases, impossible to treat. Recent outbreaks of K. pneumoniae in several Norwegian hospitals, including the neonatal intensive care unit at Stavanger University Hospital, illustrate our own vulnerability. K. pneumoniae has so far mainly been associated with hospital-acquired infections and outbreaks. However, this bacterium is ubiquitous in the environment, and may colonize and infect animals and humans. So far, K. pneumoniae has not been considered a zoonotic pathogen, and therefore not been a subject for surveys in the food production chain. Consequently, more knowledge considering the role of K. pneumoniae as a commensal in animals and humans, and the contribution of foodborne K. pneumoniae to human infection needs to be addressed. In terms of public health and food safety, such knowledge is fundamental in our approaches to elucidate transmission lines between reservoirs and containment of this important pathogen. The partners of the proposed network represent the fields of human and veterinary microbiology and medicine, environmental microbiology, and food safety. NOR-KLEB-NET will continue to enable an important cross-compartment collaboration between different sectors and with international leading scientists. NOR-KLEB-NET focus on the evolution and spread of AMR in K. pneumoniae from a One Health perspective, encompassing this pathogens ability to colonize and possibly disseminate between humans, animals, food, and environment, and to cause severe and difficult to treat infections in humans and animals. Partners from NOR-KLEB-NET achieved in 2019 in collaboration with international partners funding from the Trond Mohn Foundation for the AMR One Health project KLEB-GAP (Klebsiella pneumoniae – a key driver in the global spread of antimicrobial resistance and a target for new approaches in diagnostics, surveillance and alternative therapeutics). In this project we aim to 1) study the population structure of K. pneumoniae by whole genome sequencing, including antimicrobial resistance and virulence features, in several collections of K. pneumoniae from healthy and infected humans, animals and the marine environment; 2) explore new methods, including metagenomics, for detection and surveillance of K. pneumoniae; 3) identify novel genes associated with virulence or AMR in K. pneumoniae using advanced bioinformatics and biostatistics methods; and 4) pre-clinical evaluation of selected bacteriophages as an alternative treatment option for multidrug resistant K. pneumoniae.

NOR-KLEB-NET was established in September 2017 after receiving AMR One Health network funding from the Research Council of Norway (RCN) for two years. The network was based on an ongoing collaboration within the human sector through “The Norwegian Klebsiella pneumoniae study” (NOR-KLEB), a national multicenter research project. Through NOR-KLEB-NET a cross-sectorial collaboration between the human, veterinary and environmental sectors was established. A systematic collection of Kp-strains from different sectors was initiated using common methods. Our first workshop was held outside Stavanger in May 2018 with 35 participants, including international leading scientists in the field of AMR and Kp. The next workshop will be in Tromsø, August 21-23 2019. Moreover, several NOR-KLEB-NET partners recently received joint funding from Bergen research foundation in collaboration with international partners for the AMR One Health research project KLEB-GAP. NOR-KLEB-NET is also represented in the recently established and JPIAMR funded One Health Kp network KlebNet. Kp research activities have so far been limited with regard to the environmental, veterinary and food sectors. However, through the activities in NOR-KLEB-NET and the KLEB-GAP project, research within these sectors will be significantly strengthened. Further funding of NOR-KLEB-NET would support planned activities within the frame of NOR-KLEB and KLEB-GAP, enable us to consolidate and expand the existing network, and support our work for competitive international funding, aiming at JPIAMR and Horizon 2020. We suggest to expand the network with new partners from the environmental sector and the food safety sector to address Kp in terms of environmental dissemination and zoonotic transmission/infection. We also suggest to include a new Norwegian partner with ongoing projects in East Africa to support Kp-research activities in a low- and middle-income country perspective.