The edition · Infectious Diseases
Klebsiella and Acinetobacter dominate neonatal sepsis deaths, and the empirical regimen does not cover them
Post-mortem data from 2,609 neonatal deaths across Africa and Bangladesh put Gram-negative organisms behind three-quarters of infection deaths; artemisinin resistance surveillance is using the wrong threshold in Africa; and a single-dose-plus-booster pneumococcal schedule holds at five and a half years.
The edition in brief
The infectious diseases desk today is dominated by an LMIC pathogen picture that does not match what most empirical regimens cover. CHAMPS investigated 2,609 neonatal deaths across six African countries and Bangladesh using minimally invasive tissue sampling: infection lay somewhere in the causal pathway in 44.0%, and was the underlying cause in 16.6%. Gram-negative organisms accounted for 74.1% of infection-related deaths, led by Klebsiella pneumoniae (41.7%), Acinetobacter baumannii (25.7%) and E. coli (10.4%); Group B Streptococcus reached only 5.7%. Over 80% were judged avertable under current or improved facility conditions. A systematic review of 96 studies found that the parasite clearance half-life thresholds used to define artemisinin partial resistance, derived in southeast Asia, do not detect the phenotype in east Africa, where independently emergent kelch13 mutations clear quickly despite raised ring-stage survival — a surveillance blind spot rather than an absence of resistance. Five mpox antigen rapid tests evaluated on lesion swabs from 190 patients in Kinshasa ranged in sensitivity from 39.2% to 77.3% with specificity of 93.5% to 96.8%, so a positive result is usable where prevalence is high and a negative result rules nothing out. A small Korean randomised trial found 7-day fexuprazan triple therapy comparable to 14-day rabeprazole triple therapy for H. pylori, though both fell below acceptable eradication overall. And 5.5 years into a Vietnamese cluster-randomised trial, a one-dose-plus-booster PCV10 schedule remained non-inferior to three-dose schedules for vaccine-type carriage, with equivalent indirect protection in adult caregivers.
Neonatal sepsis deaths in LMICs are Gram-negative, and mostly Klebsiella
Review your unit's empirical neonatal sepsis regimen against its own Gram-negative isolates rather than against a Group B Streptococcus-era protocol.
Artemisinin resistance surveillance is looking for the wrong signal in Africa
Do not read a normal parasite clearance time as evidence of artemisinin susceptibility in African-origin or African-linked infections.
Mpox rapid tests: a positive is usable, a negative is not
Treat a positive mpox antigen test as actionable in an outbreak setting and a negative one as uninformative — keep the patient isolated and get PCR.
A shorter H. pylori regimen matches a longer one, at a rate neither should be proud of
Choose the H. pylori regimen on local clarithromycin resistance, not on duration — in most of India that means bismuth quadruple therapy, not triple.
A blood culture bottle volume is a diagnostic decision
Fill the bottle to its mark and take two sets from two sites before the first antibiotic dose — volume and timing decide the result more than anything downstream.
One pneumococcal dose plus a booster still holds at five and a half years
A one-dose-plus-booster PCV schedule is a defensible programmatic choice in an established programme — carriage control and herd protection held for five and a half years.
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