Infectious disease outbreaks among hospitalised neonates in low- and middle-income countries: a systematic review.

Gram-negative bacteria accounted for 74% of 172 neonatal unit outbreaks in 32 LMICs, with Klebsiella spp. detected in 35% of outbreaks.

• Why it matters: Consolidated outbreak data are limited, hindering outbreak investigation, infection prevention and control, and treatment strategy planning in LMIC neonatal units.
• What they did: A systematic review (PROSPERO: CRD420251054148) identified bacterial or fungal outbreak reports from 1 January 2015 to 31 July 2025 across multiple databases, with one-stage meta-analyses estimating pooled AMR proportions.
• The result: Klebsiella spp. showed high pooled resistance to third-generation cephalosporins (1.00 [95% CI: 0.30–1.00]), carbapenems (0.71 [0.56–0.84]), and MDR (0.89 [0.80–0.95]); molecular typing was done in 63% and WGS in 26%, identifying transmission pathways in 47% of WGS-used outbreaks.