Contribution of nosocomial transmission to Klebsiella pneumoniae neonatal sepsis in Africa and South Asia: An observational study of infection clusters inferred from pathogen genomics and temporal dat

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Klebsiella pneumoniae is the leading cause of neonatal sepsis in low- and middle-income countries in Africa and Asia.
An observational study using pathogen genomics and temporal data estimated nosocomial transmission clusters.
Analysis of 1,523 isolates from 27 neonatal units in 13 countries found 156 transmission clusters.
68% of neonatal infections (1,035 cases) were part of nosocomial transmission clusters.
At least 57.7% of infections (879 cases) were acquired via nosocomial transmission after excluding index cases.
Results were robust across different genetic distance thresholds and temporal thresholds of 2 to 8 weeks.
Most isolates were ESBL producers (90.9%), and 172 multi-locus sequence types (STs) were identified.
Fourteen STs, including globally recognized multidrug-resistant lineages, were linked to transmission clusters across multiple units, accounting for two-thirds of infections.
Carriage of carbapenemase and ESBL genes was significantly associated with transmission.
Improved infection prevention and control in neonatal units could reduce the sepsis burden.

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