Risk factors and outcome of Klebsiella sepsis in neonates

Sepsis is the leading cause of morbidity and mortality among neonates worldwide [1]. Hospital-based studies suggest an incidence of 30 per 1000 live births [2], whereas the incidence of 2.7–17% was seen in community-based studies [2-4]. The National Neonatal Perinatal Database of India showed the incidence of culture-proven sepsis cases as 8.5 per 1000 live births [2]. If sepsis manifests within the first 72 h of life, it is termed as early-onset sepsis (EOS) and after 7 days, it is lateonset sepsis (LOS). Maternal genitourinary tract is predominantly colonized by Gram-negative bacteria which is a proven risk factor for EOS. Risk factors for EOS are chorioamnionitis, maternal intrapartum fever, prematurity, prolonged rupture of membranes, and inadequate intrapartum antibiotic prophylaxis [5]. Nosocomial infections, prematurity, prolonged hospitalizations, use of central lines, parenteral feeding, and mechanical ventilation are considered as risk factor for LOS [6]. Klebsiella is a Gramnegative, encapsulated, non-motile, lactose fermenting, and facultative anaerobic bacillus and is the most common organism isolated in EOS [1,7,8]. It is known to cause pneumonia, meningitis, and septicemia. Capsule or slime layer protects Klebsiella from host defenses, which is used for its serologic identification. The unique ability of Klebsiella to survive in the hospital environment and rapid spread in neonatal intensive care unit (NICU) results in outbreaks [9]. Carbapenem-resistant Enterobacteriaceae are known to cause invasive infections and have high mortality rates. These organisms carry genes conferring high level of resistance to penicillin, carbapenems, and other antimicrobials often leaving with limited therapeutic options. The aim of the present study was to assess the risk factors, clinical profile, and outcomes of Klebsiella in neonatal sepsis (NS).