An overview of Klebsiella pneumoniae ST392 amid the AMR silent pandemic and consequent environmental dissemination and health risks.

Antimicrobial resistance (AMR) is widely recognized as the silent pandemic, leading the World Health Organization (WHO) to prioritize critical bacterial pathogens that demand urgent, innovative responses. Klebsiella pneumoniae, marked by extensive resistance to last-resort antibiotics and the absence of an effective vaccine, is among the most consequential of these threats. While high-profile sequence types (STs) such as ST258, ST512, ST101, ST307, ST147 and ST395 dominate interventions of healthcare-associated infections, other clinically important lineages remain underexplored. One such lineage is ST392, a member of clonal group 147 (CG147), increasingly reported in clinical settings worldwide. Here, we describe what is currently known about nosocomial K. pneumoniae ST392 isolates and their impact within an environmental and One Health framework, examining how clinical reservoirs interface with hospital effluents and municipal wastewater treatment plants (WWTPs) that can carry antimicrobials, antimicrobial-resistance genes (ARGs) and resistant bacteria into broader ecosystems. We synthesize current evidence on the epidemiology, resistome/virulome features, and putative dissemination pathways of ST392 across clinical and environmental compartments and consider how wastewater-based epidemiology can act as a sentinel for emergence and spread. Finally, we outline priorities for integrated surveillance and control, linking clinical microbiology, environmental monitoring and genomics, and discuss implications for infection prevention and control, stewardship, and wastewater management. In conclusion, we show the need for targeted strategies that address the full spectrum of K. pneumoniae lineages, including underrecognized ST392, to mitigate AMR risk to population health.