Genomic Characterization of Klebsiella pneumoniae Causing Invasive Disease in South African Infants: Observational Studies Between 2018 and 2023 - Scorecard - MDSpire
Advertisement
Genomic Characterization of Klebsiella pneumoniae Causing Invasive Disease in South African Infants: Observational Studies Between 2018 and 2023
Clinical Scorecard: Genomic Analysis of Klebsiella pneumoniae Linked to Invasive Infections in Infants in South Africa: Observational Research from 2018 to 2023
At a Glance
Category
Detail
Condition
Invasive Klebsiella pneumoniae infections causing sepsis and death in infants ≤90 days
Key Mechanisms
Multidrug resistance including carbapenem resistance; diverse clonotypes and antigenic profiles influencing virulence and vaccine targets
Target Population
Young infants (≤90 days) in South Africa, including hospitalized and postmortem cases
Care Setting
Hospital surveillance and postmortem minimally invasive tissue sampling in public health facilities
Key Highlights
337 KPn isolates analyzed from hospital surveillance and postmortem sampling between 2018 and 2023.
85 distinct clonotypes identified; ST17 (22.0%) and ST39 (12.7%) predominated.
85% of isolates harbored multidrug resistance genes; 32.9% resistant to carbapenems with blaOXA-181 most common.
Guideline-Based Recommendations
Diagnosis
Blood culture and lumbar puncture recommended for infants hospitalized with suspected sepsis or meningitis.
Postmortem minimally invasive tissue sampling (MITs) within 24-72 hours of death to determine cause of death.
Management
Empiric antibiotic treatment for neonates with suspected sepsis: ampicillin and gentamicin if hospitalized within 72 hours of birth or admission.
Repeat cultures during hospitalization to assess antibiotic response or new sepsis events.
Monitoring & Follow-up
Surveillance of antimicrobial resistance patterns, especially carbapenem resistance genes (blaOXA-181, blaNDM-5, blaNDM-1).
Genomic surveillance to monitor circulating KPn strains and inform vaccine target development.
Risks
High case-fatality risk (27%-56%) in sub-Saharan Africa compared to lower rates in high-income countries.
Multidrug resistance complicates treatment and increases mortality risk.
Limited access to diagnostic facilities in LMICs may underestimate disease burden.
Patient & Prescribing Data
Infants ≤90 days hospitalized with presumed serious bacterial infection in South African public hospitals.
Standard empiric therapy includes ampicillin and gentamicin; however, high prevalence of multidrug resistance, including carbapenem resistance, necessitates ongoing evaluation of antibiotic efficacy.
Clinical Best Practices
Implement standardized blood and CSF cultures for early detection of KPn in suspected neonatal sepsis.
Use multidisciplinary panels to determine cause of death incorporating antemortem and postmortem data.
Conduct genomic surveillance to identify prevalent KPn strains and resistance genes to guide treatment and vaccine development.
Consider local antimicrobial resistance patterns when selecting empiric antibiotic regimens.
Promote vaccine research targeting dominant K and O antigen loci prevalent in regional KPn isolates.
by Courtney P Olwagen, Alane Izu, Shama Khan, Stephanie Jones, Carmen Briner, Gaurav Kwatra, Lara Van der Merwe, Nicholas J Dean, Vicky L Baillie, Sana Mahtab, Kimberleigh Storath, Imaan Dunn, Lubomira Andrew, Urvi Rajyaguru, Firdose L Nakwa, Sithembiso C Velaphi, Jeannette Wadula, Renate Strehlau, Anika M van Niekerk, Niree Naidoo, Yogandree Ramsamy, Mohamed Said, Robert G K Donald, Raphael Simon, Ziyaad Dangor, Shabir A Madhi
