Escalating carbapenem-resistant Klebsiella burden and mortality in Bangladeshi infants
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Klebsiella infections in young infants are an escalating threat in low- and middle-income countries, yet robust hospital burden and antimicrobial-resistance data informed by genomics remain scarce. We performed an 18-year (2004-2021) prospective, multicenter genomics epidemiology study across four hospitals in Bangladesh. Among 122,353 enrolled children with suspected sepsis, 1,600 (1.3%) yielded culture-confirmed Klebsiella pneumoniae species complex (KpSC) isolates, which increased from 16 per 1,000 cases tested in 2004 to 37 in 2021. Hospital case-fatality rate (CFR) increased from 21.4% to 51.4%, following an increase in carbapenem resistance (first detected in 2008; 81% by 2021). Neonates accounted for 80.7% of infections with a CFR of 40.8%. Whole-genome sequencing of 599 representative isolates revealed four Klebsiella species, 145 sequence types and 92 capsular loci. Global high-risk clones ST11, ST16 and ST147 harbouring NDM-type carbapenemases dominated recent cases. Stronger infection control, access to new drugs, and multivalent vaccines are urgently needed.
