Combined Infection Control Strategy Limits Drug-Resistant Outbreak in NICU

Neonatal sepsis remains a leading cause of death in low- and middle-income countries, where overcrowded facilities and limited resources heighten transmission risks from multidrug-resistant pathogens. Klebsiella pneumoniae is a frequent cause of bloodstream infections in these settings, complicating rapid diagnosis and treatment. Practical, low-cost prevention strategies are needed to interrupt spread within neonatal intensive care units. A new study shows that a multifaceted infection prevention approach can temporarily disrupt K. pneumoniae transmission in a high-burden setting.

Boston University School of Public Health (BUSPH) and the London School of Hygiene & Tropical Medicine (LSHTM) evaluated a bundle of infection prevention and control (IPC) measures alongside whole-genome sequencing (WGS) to investigate a prolonged K. pneumoniae outbreak in a Zambian neonatal intensive care unit. WGS—the gold standard for bacterial identification—was used to delineate transmission patterns and outbreak dynamics. The analysis found that the IPC bundle successfully interrupted a large, long-running outbreak but did not eradicate transmission entirely. 

The IPC bundle, implemented over 12 months, comprised staff IPC training, text message reminders of key practices, onsite production of World Health Organization–formulated alcohol hand rub, enhanced unit-wide cleaning, and weekly bathing of newborns with 2% chlorhexidine gluconate. Using blood samples collected during the Sepsis Prevention in Neonates in Zambia (SPINZ) study, investigators applied WGS to 411 K. pneumoniae isolates to track development and spread of strains before and after the interventions. Neonatal mortality was lower during the IPC intervention period.

While initial transmission was contained, some bacteria reemerged and new strains appeared, leading to additional infections. Most tested isolates produced extended-spectrum beta-lactamases (ESBLs), conferring resistance to penicillin and other common antibiotics, and a few carbapenemases were detected, indicating resistance to last-resort carbapenems. Notably, nearly 35% of K. pneumoniae infections occurred within 2448 hours of admission, and most infections likely originated from contaminated sources within the unit rather than from outside the hospital.

Published in PLOS Global Public Health, the findings underscore the value of continued IPC programs and whole-genome surveillance in resource-limited hospitals to mitigate pathogen spread. The authors note that carbapenem resistance is already emerging in countries such as India and Thailand, narrowing therapeutic options and heightening the importance of prevention. The original evaluation of the IPC interventions in SPINZ was published in Clinical Infectious Diseases in 2019. 

“Neonatal sepsis is one of the major causes of death among children in the first 28 days of life. In low- and middle-income countries, the quality of infection prevention and control measures can be very limited and, as a result, there is a lot of cross-transmission from infected equipment or healthcare workers. Our study found that a variety of preventive measures worked to temporarily clear the main serotype while concurrently decreasing neonatal mortality, suspected sepsis, and confirmed bloodstream infections with true pathogens,” said Davidson Hamer, professor of global health and medicine at SPH and BU Chobanian & Avedisian School of Medicine.

Related Links
Boston University School of Public Health
London School of Hygiene & Tropical Medicine