KlebNet: a One Health network bridging science and surveillance on antimicrobial resistant Klebsiella

Klebsiella, particularly Klebsiella pneumoniae (hereafter, collectively called Kp) is an opportunistic pathogen of humans and animals that now tops the ‘urgent threat’ lists of CDC, ECDC and WHO due to high rates of multidrug resistance. Kp can also play a pioneer role in the amplification of novel AMR mechanisms acquired from environmental microbes, which can then spread to other important bacterial pathogens, as exemplified with KPC-2 or NDM-1 carbapenemases. Despite this, Kp does not currently feature as a target of surveillance efforts. Although Kp is generally viewed as ‘ubiquitous’, data on its distribution in healthy people, the environment, animals and the food chain are scarce, and the transmission of Kp and its AMR gene cargo between these potential sectors and hospitalised individuals is poorly understood. The KlebNet network is dedicated to identifying key knowledge gaps relating to Kp ecology and transmission, and to developing a One Health strategy for Kp surveillance. Strategy: Research on ecological distribution of Kp and on its transmission routes should, to be actionable, be guided by expected impact on implementation into surveillance and control programs. An optimal Kp surveillance strategy must be defined based on (1) Most advanced knowledge on the ecology, population biology and epidemiology of the pathogen, combined with (2) Actionability and practical aspects of the implementation of surveillance, in high-income as well as in low- and medium income countries (LMIC), and across sectors (clinical, animal, food). Objectives: (1) To review current knowledge on Kp reservoirs, population biology and transmission dynamics, and to identify and prioritise gaps where further research is required; and (2) To issue recommendations on how Kp surveillance should be implemented and harmonised across environment, animals, food and hospitals, including both technical and strategic considerations.