High Burden of Carbapenem-resistant Klebsiella pneumoniae (CRKP) Colonization in Neonates in A Tertiary Care Hospital in India

Neonatal sepsis due to carbapenem-resistant Klebsiella pneumoniae (CRKP) is a global cause of morbidity and mortality, especially in East and Southeast Asia. Among different sources of CRKP implicated in sepsis, neonatal skin and gut colonization are important reservoirs. Despite being endemic for CRKP infections, there is an extreme paucity of data on CRKP colonization in neonates. Therefore, this prospective cohort study was performed to detect the frequency of gut colonization with CRKP in the neonates following admission in the neonatal unit of a tertiary care hospital in India. The study was conducted in the 14 bedded neonatal unit and infection control section. Surface swabs from skin and rectal swabs were cultured for bacterial identification from every neonate at admission and at 24 h, 48 h, and 72 h. Isolates were genotypically tested for phylogeny groups, screened for carbapenem resistance by imipenem E-test and typed by Enterobacterial Repetitive Intergenic Consensus (ERIC) PCR. Data for the CRKP colonized and non-colonized neonates were statistically analyzed. A total of 30 neonates and 180 swabs were studied. Gram-positive cocci in skin, whereas for rectal colonization, K. pneumoniae (genotype K. pneumoniae subsp. pneumoniae) was the commonest. The frequency of CRKP colonization was 33%, with 20% colonization pressure at admission. All the CRKP had blaNDM gene. On ERIC-PCR, multiple clones were seen. The study highlighted the high burden of blaNDM carrying CRKP colonization in neonates at admission, thus emphasizing the urgent need for the implementation of stringent infection control policies to prevent nosocomial transmission of these colonizers.