P-362. Outbreak of neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023

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Abstract Background Sepsis is a leading cause of neonatal mortality and morbidity worldwide, notably in Kyrgyzstan. In January 2023, six neonatal sepsis deaths were reported within two weeks at a 157-bed maternity hospital, which usually has < 2 cases/month. We investigated to identify sources of infection and risk factors.Table 1.Factors associated with neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023*AOR- adjusted odds ration; ** CI- confidence interval; ***1. Healthy population (Reference group): Apgar scores at 1 and 5 min above 7; Unhealthy population: Apgar scores at 1 min below 7 and at 5 min below 7; Improved population: least one below 7 Methods A concurrent case-control study included infants (< 28 days old) born at the hospital in January 2022-February 2023 and diagnosed with sepsis. Controls met same criteria and were born +/- 1 day from cases without sepsis. In February 2023, we collected rectal, nasopharyngeal, and high-touch environmental areas swabs in a single-day cross-sectional sample of hospitalized case-patients and mothers for culturing and MALDI-TOF. We used logistic regression to identify factors associated with sepsis.Figure 1.Two clusters of Acinetobacter baumannii detected among newborns with neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023 Results The study comprised 129 cases and 509 controls. More cases than controls weighed < 2500g at birth (52% vs 5%, p< 0.01), had anhydrous interval of ≥12 hours (43% vs 29%, p< 0.01), had Apgar scores of < 7 at 1 minute (83% vs 20%, p< 0.01), were more likely to receive both ventilation and an invasive device (98% vs 1%, p< 0.01) and to be admitted to the intensive-care unit (ICU) (82% vs 17%, p< 0.01) (Table 1). Sepsis was associated with birth weight of ≤2500g vs greater (adjusted odds ratio: 5.6; 95% confidence interval: [2.1-15.1]), infant blood transfusion vs no (9.9 [3.8-26.0]), use of ventilation and invasive device vs no (144 [28.8-729.7]), Apgar scores at 1 and 5 minutes < 7 vs greater (2.8 [1.0-7.8], urinary tract disease in mother vs not (3.5 [1.1-10.6]), and anhydrous interval ≥12 hours vs less (2.6 [1.2-5.5]). Acinetobacter baumannii resistant to cephalosporins, aminoglycosides, and fluoroquinolones was detected in 8/8 pharyngeal swabs from case-patients in two ICU rooms, forming two distinct clusters (Figure 1). Acinetobacter baumannii was not detected in environmental sampling, but the hospital had conducted deep cleaning shortly before the environmental team arrived. Conclusion Resistant Acinetobacter baumanni likely contributed to the outbreak. The hospital conducted environmental cleaning, replaced non-disposable instruments (cannulas, masks, tubes) and updated infection control practices. Neonatal sepsis cases dropped sharply to < 2/month by May 2023. Disclosures All Authors: No reported disclosures