‘Consociatio vita minabatur procursus’: Citrobacter freundii outbreak causing periculosus neonatal septicaemia in neonatal intensive care unit of tertiary care hospital

Abstract

Abstract Background: Citrobacter freundii is a common cause of neonatal intensive care unit (NICU) outbreaks, causing high morbidity and mortality as a hospital-acquired pathogen. This is the first study from our geographic region, which makes it of utmost importance for spreading awareness about this unusual pathogen amongst healthcare settings. Aim: Investigating an outbreak caused by C. freundii in the NICU of a tertiary care hospital. Settings and Design: During the month of May 2023, an outbreak of C. freundii causing neonatal septicaemia was suspected in the NICU of a tertiary care hospital in Western Uttar Pradesh. The outbreak was investigated and surveillance conducted by the hospital infection control (HIC) team, to find a source of the infection by root cause analysis (RCA), to study clinical profiles and outcomes, to determine their antimicrobial susceptibility pattern, to take corrective action preventive action (CAPA). Materials and Methods: A total of 132 blood samples were tested for blood culture and sensitivity using the BD FX40 system. Positive flagged bottles were processed for Gram stain and sub-cultured on 5% sheep blood agar and MacConkey’s agar media plates. Final bacterial identification and antibiotic susceptibility were done with an automated BD-Phoenix M-50 system. Results: C. freundii with similar antimicrobial susceptibility was identified in seven neonates, contributing to a major percentage of neonatal blood culture positivity of 13.7%, out of a total positivity rate of 38.63%. The mortality rate of this outbreak was 28.57%. The HIC team investigates this outbreak for CAPA and RCA. On environmental surveillance, C. freundii was isolated from infant incubators, dressing trolleys, and laryngoscope blades of the NICU. Discussion: C. freundii association in Blood culture from critical areas patients is life-threatening ‘Consociatio Vita Minabatur Procursus’. Direct access to the bloodstream causing neonatal septicaemia in a short time is a concern for its potential severity, making it as ‘Periculosus Pathogen’. Laboratory automation and implementation of strict infection control strategies in critical areas can improve clinical outcomes and prevent future outbreaks.