Risk factors and outcome of Klebsiella pneumonia sepsis among newborns in Northern India

Mahvish Qazi, Najmus Saqib, Rohit Raina


Background: The increasing clinical incidence of antibiotic-resistant bacteria is a major global health care issue. Among MDR pathogens, Klebsiella pneumoniae (KP) is one of the world's most dangerous superbugs; and becoming resistant to virtually every antibiotic available today. The objective were to study the clinical characteristics of neonatal sepsis caused by KP and the antibiotic sensitivity pattern of Klebsiella pneumoniae in a neonatal intensive care unit (NICU) in northern india.

Methods: This observational study was conducted with neonates who were admitted in NICU of Government Medical College (GMC) Jammu (Jammu and Kashmir) India and whose blood culture showed growth of KP in a study period of 1 year between 1st January 2018 to 31st December 2018. The data was entered into a register and presented by descriptive statistics.

Results: Twenty four neonates were included in the study. The clinical presentations include refusal of feed (83.3%), lethargy (79.2%), respiratory distress (70.8%), shock (70.8%), fever (37.5%) or hypothermia (58.3%), apnea (29.2%) and abdominal distension (33.3%). Most common perinatal risk factor was prolonged labor (>24 h) seen in 79.2% of cases. C-reactive protein (CRP) level was positive in 95% of the cases. The mortality was 25%. KP strains were sensitive to colistin, polymyxin B, cotrimoxazole and tetracyclines.

Conclusions: The clinical manifestations of neonatal sepsis caused by KP are usually non-specific. CRP detection is valuable for early diagnosis of sepsis. Neonatal sepsis persists as a cause of mortality in this region. Regular antimicrobial surveillance for empirical treatment remains an important component of neonatal care.


Drug sensitivity, Klebsiella pneumoniae

Full Text:



Stoll BJ. Infections of the neonatal infant. In: Nelson Textbook of Pediatrics, Behrman Ed., Kleigman RE, RM, Jenson HB. Philadelphia: W.B. Saunders. 17th ed. 2004:623-39.

Edwards MS. Postnatal infections In: Fanaoff and Martins Neonatal-perinatal Medicine. 8th ed. Philadelphia: Mosby Elsevier; 2006:791-804.

Vergnano S, Sharland M, Kazembe P, Wansambo CM, Heath PT. Neonatal sepsis, an international perspective. Arch Dis Child Fetal Neonatal Ed. 2005;90:F220-F224.

Bakr AF. Intravenous lines‐related sepsis in newborn babies admitted to NICU in a developing country. J Trop Pedia. 2003 Oct 1;49(5):295-7.

Joshi SG, Ghole VS, Niphadkar KB. Neonatal Gram-negative bacteremia. Indian J Pediatr. 2000;67(1):27-32.

Köksal N, Hacimustafaoğlu M, Bağci S. Meropenem in neonatal severe infections due to multiresistant gram-negative bacteria. Indian J Pediatrics. 2001 Jan 1;68(1):15-9.

Roilides E, Kyriakides G, Kadiltsoglou I, Farmaki E, Venzon D, Katsaveli A, et al. Septicemia due to multiresistant Klebsiella pneumoniae in a neonatal unit: a case-control study. Am J Perinatol. 2000;17(01):035-40.

Stoll BJ, Hansen N, Fanaroff AA,Wright LL, CarloWA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002;110:285-91.

Zaidi AK, Thaver D, Ali SA, Khan TA. Pathogens associated with sepsis in newborns and young infants in developing countries. Pediatr Infect Dis J. 2009;28(Suppl. 1):S10-8.

Vergnano S, Menson E, Kennea N, Embleton N, Russell AB, Watts T, et al. Neonatal infections in England: the Neon in surveillance network. Arch Dis Child Fetal Neonatal Ed. 2011;96:F9-14.

Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis. J Trop Pediatr. 2015;61:1-13.

Shon AS, Bajwa RP, Russo TA. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed. Virulence. 2013;4:107-18.

Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998;4:589-603.

Haller S, Eller C, Hermes J, Kaase M, Steglich M, Radonic A, et al. What caused the outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit, Germany 2009 to 2012? Reconstucting transmission with epidemiological analysis and whole-genome sequencing. BMJ. 2015;5:e007397.

Khaertynov KhS, Anohin VA, Nikolaeva IV, Semenova DR, Lyubin SA, Agapova IV. Neonatal sepsis caused by Klebsiella. Med News North Caucasus. 2016;1s1:82-6.

Gelband H, Miller-Petrie M, Pant S, Gandra S, Levinson J, Barter D, et al. The State of the World’s Antibiotics. Washington, DC: Center for Disease Dynamics, Economics, Policy; 2015.

Liu YC, Cheng DL, Lin CL. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. 1986;146:1913-6.

Cheng DL, Liu YC, Yen MY, Liu CY, Wang RS. Septic metastatic lesions of the pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch Intern Med. 1991;151:1557-9.

Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wang JH, et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 1998;26:1434-8.

Decré D, Verdet C, Emirian A, Le Gourrierec T, Petit JC, Offenstadt G, et al. Emerging severe and fatal infections due to Klebsiella pneumoniae in two university hospitals in France. J Clin Microbiol. 2011;49:3012-304.

Bialek-Davenet S, Criscuolo A, Ailloud F, Passet V, Jones L, Delannoy-Vieillard AS, et al. Genomic definition of hypervirulent and multi drug resistant Klebsiella pneumoniae clonal groups. Emerg Infect Dis. 2014;20:1812-20.

Yu WL, Ko WC, Cheng KC, Lee HC, Ke DS, Lee CC, et al. Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan. Clin Inect Dis. 2006;42:1351-8.

Zhang R, Lin D, Chan EW, Gu D, Chen GX, Chen S. Emergence of carbapenem-resistant serotype K1 hypervirulent Klebsiella pneumoniae strains in China. Antimicrob Agents Chemother. 2015;60:709-11.

Surgers L, Boyd A, Girard PM, Arlet G, Decré D. ESBL-producing strain of hypervirulent Klebsiella pneumoniae K2, France. Emerg Infect Dis. 2016;22:1687-8.

Paczosa MK, Mecsas J. Klebsiella pneumoniae: going on the offense with a strong defense. Microbiol Mol Biol Rev. 2016;80:629-61.

Zhang Y, Zhao C, Wang Q, Wang X, Chen H, Li H, et al. High prevalence of hypervirulent Klebsiella pneumoniae infection in china: geographic distribution, clinical characteristics, and antimicrobial resistance. Antimicrob Agents Chemother. 2016;60:6115-20.

Waliullah MS, Islam MN, Siddika M, Hossain MK, Hossain MA. Risk factors, clinical manifestation and bacteriological profile of neonatal sepsis in a tertiary level pediatric hospital. Mymensingh Med J. 2009;18:S66-S72.

Iregbu KC, Elegba OY, Babaniyi IB. Bacteriological profile of neonatal septicaemia in a tertiary hospital in Nigeria. Afr Health Sci. 2006;6:151-4.

Shitaye D, Asrat D, Woldeamanuel Y, Worku B. Risk factors and etiology of neonatal sepsis in Tikur Anbessa University Hospital, Ethiopia. Ethiop Med J. 2010;48:11-21.

Banerjee M, Sahu K, Bhattacharya S, Adhya S, Bhowmick P, Chakraborty P. Outbreak of neonatal septicemia with multidrug resistant Klebsiella pneumoniae. Indian J Pediatr. 1993;60:25-7.

Mai JY, Zhu ML, Chen C, HeXL, Lin ZL. Clinical characteristics of neonatal Klebsiella pneumoniae sepsis and its antibiotic sensitivity pattern of strains. Zhonqquo Dong Dai Er Ke Za Zhin. 2016;12(9):700-3.

Harish BN, Menezes GA, Shekatkar S, Parija SC. Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae from blood culture. J Med Microbiol. 2007;56:999-1000.

Zhou J, Li G, Ma X, Yang Q, Yi J. Outbreak of colonization by carbapenemase-producing Klebsiella pneumoniae in a neonatal intensive care unit: Investigations, control measures and assessment. Am J Infection Control. 2015;43(10):1122-4.

Serefhanoglu K, Turan H, Timurkaynak FE, Arslan H. Bloodstream infections caused by ESBL-producing E. coli and K. pneumoniae: risk factors for multi drug resistance. Braz J Infect Dis. 2009;13:403-7.

Taneja N, Rao P, Arora J, Dogra A. Occurrence of ESBL and Amp-C beta-lactamases and susceptibility to newer antimicrobial agents in complicated UTI. Indian J Med Res. 2008;127:85-8.

Cassettari VC, Silveira IR, Balsama AC, Franco F. Outbreak of extended spectrum beta-lactamase producing Klebsiella pneumonia in an intermediate risk neonatal unit linked to onychomycosis in a health care worker. J Pediatrics. 2006;82(4):316-26.

Wyoming Department of Health. Burke K. Section 12: Antibiotic Stewardship - Wyoming Department of Health, 2014. Available at: Accessed on 1 June 2017.

Spellberg B, Bartlett JG, Gilbert DN. The future of antibiotics and resistance. N Engl J Med. 2013;368:299-302.

Haq IU, Chaudhry WN, Akhtar MN, Andleeba S, Qadri I. Bacteriophages and their implications on future biotechnology: a review. Virol J. 2012;9(1):9.