The European Centre for Disease Prevention and Control has recently published the third update on the invasive carbapenem-resistant Enterobacterales. The report’s main findings are not unexpected. The incidence of carbapenem-resistant Klebsiella pneumoniae in blood stream infections is up almost 60% between 2019 and 2023 with every EU country except Finland recording a positive trend although the rate is still low at 3.97 per 100,000 population. To make matters worse, Ireland has reported sustained spread of carbapenem-resistant K. pneumoniae ST23. This strain, known for its hypervirulent phenotype, has previously been susceptible to a number of antibiotics with carbapenems often used in treatment. With the acquisition of carbapenem resistance, this strain has potential to spread rapidly through the European health care systems. On the positive side, the rate of carbapenem-resistant E. coli blood stream infections has decreased from 0.2 to 0.14 per 100,000 populations, though there are substantial regional differences. 

The rise in carbapenem resistance contrasts the shortage of new antimicrobials. Majority of the recently approved drugs are combinations of the beta-lactamases and inhibitors. However, these novel combinations have not yet supplanted the highly toxic polymyxins in clinical use with six daily doses of polymyxins used in EU/EEA for every dose of ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam and cefideroco. 

These findings serve to reinforce the need for governments to focus on tackling AMR through all possible tools: public health awareness, vaccines, improved management in health care settings and new antimicrobial research and deployment.