Multidrug-resistant Klebsiella pneumoniae in critically ill neonates: evidence from a Brazilian cohort.

BACKGROUND

Antimicrobial resistance is a global health crisis, with multidrug-resistant (MDR) Klebsiella pneumoniae infections causing significant mortality, particularly in low- and middle-income countries.

OBJECTIVE

Evaluate the incidence, risk factors, antimicrobial resistance patterns, and clinical outcomes of K. pneumoniae infections in a neonatal intensive care unit (NICU) in Brazil.

METHODS

This retrospective cohort study evaluated 1627 neonates in a Brazilian NICU from 2015 to 2022.

RESULTS

Invasive K. pneumoniae infections in 3.2% of cases, with a peak incidence of 7% in 2016. Among 62 infection episodes, 54.8% were bloodstream infections and 45.2% urinary tract infections, diagnosed at a median age of 28 days. Most isolates (98.4%) were nonsusceptible, including 41.9% MDR, 6.5% extensively drug-resistant, and 43.5% extended-spectrum beta-lactamase producers, with one carbapenem-resistant isolate. Infection extended hospital stays from 11 to 50 days and had a case fatality rate of 19.2%, with a median time to death of 5 days.

CONCLUSIONS

The findings underscore the critical burden of MDR K. pneumoniae in NICUs, emphasising the urgent need for targeted antimicrobial stewardship and effective infection control strategies to mitigate neonatal morbidity and mortality.