Outbreak of multi-drug resistant Klebsiella pneumoniae: A 4 month epidemiologic follow-up in a tertiary teaching hospital in Rwanda
Multi-drug resistant (MDR) nosocomial Klebsiella pneumoniae(KP) is an emerging problem in the developing world. MDR gram-negative infections are increasingly reported in neonatal units in resource-limited settings, with high mortality.
We describe an outbreak in a tertiary Neonatal Intensive Care Unit (NICU) at Butare University Teaching Hospital (BUTH) in Rwanda, and the infection control measures taken to interrupt transmission.
Microbiologic data from cultures taken during clinical care from infants hospitalized at BUTH NICU from January-May 2013 were reviewed. Environmental cultures were collected from equipment in contact with infected infants.
KP was isolated in 21 neonates evaluated for sepsis. Eighteen (86%) infants grew KP in blood, and 3 (14%) grew KP from infected surgical sites. Seven infants (33%) developed KP early-onset sepsis in the first 3 days of life, and 14 (67%) cases were late-onset. Mortality was high, and 5 babies died (24%). Antibiotic susceptibility testing showed high levels of resistance; 14/17 (82.5%) Gentamicin, 12/15 (80%) Cefotaxime, 4/12 (33%) Ciprofloxacin, 4/17 (24%) TMP/SMX. No isolates were resistant to Meropenem. Although most isolates had the same susceptibility pattern, clonality could not be assessed. Environmental cultures revealed KP from the water reservoir of 1 incubator. Pseudomonas aeruginosa was obtained from 1 incubator, 1 jug for transporting distilled water, 1 CPAP reservoir and 1 portable oxygen concentrator. The outbreak was controlled after temporary ward closure with terminal cleaning, infant cohorting, contact isolation, and reinforcing hand hygeine. No cases occurred after May, 2013.
An outbreak of MDR KP in a resource-limited setting was controlled by early recognition, thorough investigation, isolation and deep cleaning measures.
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