Containing a multidrug-resistant klebsiella pneumoniae outbreak in a level III NICU: A retrospective cohort study

Background:

Klebsiella pneumoniae is a leading cause of neonatal sepsis, particularly in preterm infants. The emergence of multidrug-resistant (MDR) strains poses significant challenges for NICU infection control and clinical management. In December 2024–January 2025, our Level III NICU encountered a sudden cluster of K. pneumoniae cases requiring structured outbreak containment.

Methods:

A retrospective cohort study was conducted including all neonates with culture-confirmed K. pneumoniae sepsis during the outbreak period. Maternal, intrapartum, and postnatal risk factors were extracted from clinical records. Univariate regression was performed to explore associations with mortality. Antibiotic susceptibility patterns were analysed. Infection-control interventions implemented during the outbreak were recorded and monitored.

Results:

Twenty-five neonates developed K. pneumoniae sepsis over the two-month period. Most affected infants were preterm and low birth weight. Common clinical features included respiratory distress, feeding intolerance, lethargy, and temperature instability. Significant associations with mortality were identified for multiple maternal and postnatal risk factors. Isolates exhibited multidrug resistance with carbapenem sensitivity preserved. Following reinforcement of infection-control practices—including hand hygiene compliance, equipment sterilisation, cohort nursing, and antimicrobial stewardship—the number of new cases declined sharply.

Conclusion:

This outbreak underscores the high mortality risk posed by MDR K. pneumoniae in preterm neonates. Early detection and rapid implementation of robust infection-control strategies effectively curtailed transmission. Strengthening routine surveillance and NICU hygiene practices is critical for preventing similar outbreaks in resource-limited settings.

Dr Amol Joshi MD, is Consultant Neonatologist, Quality Improvement Advisor. He holds fellowship in Neonatology (MUHS, Nashik University), Fellowship IsQua (2022), has published many articles. Mentored many Newborn Care Units in secondary health facility, Currently holding additional responsibility as Associate Editor (BMJ Open Quality).