Understanding the Factors Contributing to a Deadly Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit in India

Background: <italic>Klebsiella</italic> is an important causative organism of neonatal sepsis (NS), particularly in developing countries. This study aimed to analyze the demographic and clinical laboratory features of a fatal outbreak of <italic>Klebsiella</italic> spp. that occurred in a neonatal intensive care unit (NICU), identify the source of the infections, and propose infection control measures to prevent future occurrences. Methods: We performed a retrospective analysis of the medical records and investigative reports of sepsis cases caused by <italic>Klebsiella pneumoniae</italic> admitted to the neonatal units of a tertiary care teaching hospital in western India from May to August 2022. Results: Among the 26 neonates with <italic>Klebsiella</italic> sepsis, those born at <28 weeks and 28–32 weeks of gestation were the most affected group. The mortality rate was high (<italic>n</italic> = 21, 80%). The C-reactive protein (CRP) level was used to assess the severity and prognosis of the infection. The platelet count (PLT) decreased significantly from day 1 to 15 (<italic>p</italic> < 0.001) as the condition worsened. Elevated CRP levels (>100 mg/L) were also observed on the 5th day of admission (<italic>p</italic> < 0.001). We found unsatisfactory hand hygiene practices, and <italic>K. pneumoniae</italic> grew on surface swab sampling of wash basins and overhead water tanks. Thorough decontamination of the source of infection and strengthening of infection control practices was performed. Conclusion: Carbapenem-resistant <italic>Klebsiella</italic> strains led to substantial morbidity and mortality during an outbreak in neonates.