By Anais Cottage-stone · 25 August 2026
On Thursday, 15th May 2025, NeoNET AFRICA, in collaboration with the African Neonatal Association and KlebNET-GSP, opened its seminar series on Neonatal Outbreaks in Africa. The first session, chaired by Professor Angela Dramowski (Stellenbosch University, South Africa), focused on outbreak epidemiology: how infections spread through neonatal units, which organisms are responsible, and why the answers so often differ from what textbooks predict.
Watch the full seminar recording here.
Dr Sarah Sturrock (CREATE PhD fellow, UK) opened with a challenge to a long-held assumption. Early-onset neonatal sepsis is traditionally understood as vertically transmitted, ascending from the maternal genitourinary tract, with E. coli, Group B Streptococcus and Listeria as the usual culprits. Yet Gram-negative organisms account for an estimated 60% of African neonatal sepsis, and environmental contamination in neonatal units is well documented.
Working at a government facility in Kampala, Uganda, with roughly 3,000 births and 700 NICU admissions each month, her team compared three sources: neonatal venous blood cultures, umbilical cord blood cultures, and environmental swabs taken from the unit itself.
The organisms differed depending on where they came from, and so did their resistance patterns, strikingly so. Among Klebsiellaisolates, gentamicin resistance was 13% in cord blood but 92% in neonatal blood. For Citrobacter, the gap ran from 0% to 100%. Environmental swabs recovered organisms from sinks, cleaning mops, equipment screens, suction machines and white coats.
The implication is uncomfortable and important: sepsis presenting in the first days of life may not have come from the mother at all. Dr Sturrock was careful to note the limits of the evidence, since these findings show association rather than causation, and matched participant data will be needed to link environmental organisms directly to infections.
Dr Yunus Edris Kelil (Hiwot Fana Hospital, Ethiopia, and PhD candidate at LSHTM) presented two years of surveillance at Hiwot Fana Comprehensive Specialized Hospital, running from December 2021 to November 2023. Of 1,535 admissions screened and 1,335 blood cultures taken, 357 (27%) were positive.
The dominant organism was not one that features prominently in neonatal sepsis guidance. Pantoea agglomerans accounted for 144 isolates, some 40% of all positive cultures, well ahead of Klebsiella pneumoniae at 62 isolates (17%). Its role in neonatal infection has been treated as inconclusive in the published literature.
The data suggest it deserves closer attention. Low birthweight (under 2,500 g) and delivery at another health facility were both independently associated with P. agglomerans bacteraemia, and infection carried an increased risk of in-hospital death (odds ratio 1.84, 95% CI 1.25 to 2.70). A marked seasonal pattern also emerged, with substantially lower odds during the heavy rainy season from June to September.
Dr Kelil closed on a note that speaks to the wider diagnostic picture: on re-testing with MALDI-TOF mass spectrometry, isolates identified as P. agglomerans by conventional culture were identified as Pantoea dispersa. Knowing what you are dealing with depends on the tools available to look.
Dr Fatou Secka (Northern Ethiopia Emergency Response and Health Cluster Coordination, WHO Ethiopia) closed the session with a ten year systematic review of neonatal unit outbreaks in low and middle income countries, drawing on two decades of clinical research experience across East and West Africa.
Seminar 1 set out the epidemiological picture. The sessions that followed built on it, beginning with Seminar 2 on outbreak detection and investigation.
