Abstract
IntroductionBetween July 2014 and September 2015, a neonatal care unit (NCU) in Port Au Prince, Haiti, experienced an outbreak of sepsis, most probably due to nosocomial transmission of Extended Beta Lactamase (ESBL) producing gram negative bacteria, included Klebsiella pneumoniae.MethodsWe describe the epidemiological and microbiological activities performed as part of the outbreak investigation and the control measures implemented throughout this period.ResultsDuring the study period 257 cases of sepsis were reported, of which 191 died. The case fatality decreased from 100% in July 2014 to 24% in September 2015 and could be attributed to an improvement in clinical management and strengthened infection prevention and control measures. Risk factors identified to be associated with having late onset sepsis (sepsis onset >48 hours after birth)(n=205/257, 79. included: all categories of birthweight lower than <2500g (p=<0.0001) and all categories of gestational age younger than 36 weeks (p=0.0002). Microbiological investigations confirmed that out of 32 isolates (N=55; 58%) that were positive for gram negative bacteria, 27 (89%) were due to K. pneumoniae and most of these were from single MLST type (ST37).Discussion This outbreak highlighted the importance of epidemiological and microbiological surveillance during an outbreak of sepsis in a NCU in a low resource setting, including regular point prevalence surveys.
Highlights
Introduction Between July2014 and September 2015, a neonatal care unit (NCU) in Port Au Prince, Haiti, experienced an outbreak of sepsis, most probably due to nosocomial transmission of Extended Beta Lactamase (ESBL) producing gram negative bacteria, included Klebsiella pneumoniae
The presence and spread of Extended–spectrum beta-lactamase (ESBL) producing Enterobacteriaciae is presently an issue of global public health concern. Are these bacteria resistant to several third generation cephalosporins, but ESBL-positive isolates display resistance to other antibiotics such as fluoroquinolones, aminoglycosides and trimethoprim-sulfamethoxazole which reduces the number of effective antibiotics available for treatment 1
A recent systematic review of ESBL producing Enterobacteriaciae in neonatal intensive care units (NICUs) showed that ESBL K. pneumoniae is the most frequently implicated pathogen in outbreaks in these contexts with mortality rates up to 31% in infected infants 4 The risk of high rates of colonization and possible infection and treatment options for treatment for ESBL positive Enterbactericiae has become established as a major challenge in the care of neonates and children in hospital settings in both high and low resource contexts
Summary
Between July 2014 and September 2015, we identified 257 cases of suspected sepsis cases. A total of 96 biological samples were taken during the study period from 49 suspected sepsis cases (19%). For the gram negative bacterial isolates, 27 (49% of all isolates and 84% of all gram negative bacteria isolates) were positive for K. pneumoniae, corresponding to 27 individual sepsis cases (10.5% of all suspected cases and 55% of all sepsis cases for whom a blood isolate was available). Out of the 32 gram-negative bacterial isolates from blood culture, 24 (75%) had data available on ESBL status and they were all ESBL positive (100%); 22 were K. pneumoniae isolates. Out of the 25 isolates tested for third generation cephalosporins (i.e. cefotaxime even though ceftazidime is used as second line treatment for sepsis in CRUO), hree (12.0%) were sensitive. Four were identified with ST39 and the remainder consisted of either differing ST-types or non-typeable samples
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