A new study led by researchers at Boston University School of Public Health and the London School of Hygiene and Tropical Medicine found that a bundle of low-cost infection prevention and control measures could temporarily reduce outbreaks of Klebsiella pneumoniae infections in a Zambian neonatal intensive care unit, according to a March 10 announcement.
Klebsiella pneumoniae is a major cause of neonatal sepsis and mortality in Africa and South Asia, especially as it becomes more resistant to common antibiotics. Preventing its spread is particularly important in low- and middle-income countries where hospitals often face resource constraints and overcrowding, making it difficult to quickly diagnose sepsis cases.
The study, published in PLOS Global Public Health, used whole genome sequencing to assess the impact of several infection control steps—including staff training, text message reminders, locally produced alcohol hand rubs, enhanced cleaning, and weekly bathing of babies—on an outbreak in the Zambian NICU. The intervention disrupted a large bacterial outbreak but did not eliminate it entirely. While transmission was initially contained, some bacteria reemerged along with new strains. Most tested bacteria produced enzymes that are highly resistant to penicillin and other antibiotics; some were even resistant to last-resort carbapenem antibiotics.
Dr. Davidson Hamer, professor at Boston University School of Public Health and BU Chobanian & Avedisian School of Medicine, said: "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." Dr. Hamer also said: "These interventions are sorely needed in many areas around the world as antimicrobial resistance continues to widen." He added: "That means that there are very few options left to treat certain infections, other than very new drugs or some older toxic drugs. If we can take low-cost preventive measures to limit the infections that these antibiotics treat, we will also limit the need to use these products and stall resistance to them."
The research team analyzed blood samples collected during an earlier evaluation known as the Sepsis Prevention in Neonates in Zambia (SPINZ) study. They found most K. pneumoniae infections likely came from within the hospital rather than outside sources; nearly 35 percent occurred within two days after admission.
While efforts continue toward developing vaccines targeting K. pneumoniae—one analysis suggested a single vaccine could protect against about 70 percent of cases—the current findings highlight that ongoing infection prevention remains crucial until such vaccines become widely available.
