Extended spectrum beta-lactamase Klebsiella pneumoniae (ESBL-KP) bloodstream infection outbreak in a Neonatal Intensive Care Unit (NICU) in Bangui, Central African Republic (CAR).

Abstract

Background: Multidrug-resistant organism (MDRO) outbreaks in NICUs cause high mortality and strain hospital resources globally, particularly in low-income countries (LICs). In Central African Republic (CAR), limited data on antimicrobial resistance indicate high rates of MDRO. We describe an outbreak of Extended Spectrum Beta-Lactamase-producing Klebsiella pneumoniae (ESBL-KP) in a Ministry of Health (MoH) hospital NICU in Bangui, supported by Médecins Sans Frontières (MSF).

Methods: This retrospective case-control study was conducted at the Centre Hospitalier Universitaire Communautaire-MSF project of Bangui. The study included all neonates admitted to the NICU from 25/10/2023, the admission date of the first confirmed case, to 14/01/2024, the discharge date of the last case. Cases were defined as laboratory-confirmed ESBL-KP bloodstream infections (BSI) with similar resistance profiles, differing by no more than three antibiotic classes based on phenotypic testing. Line lists and routinely encoded data were used, and variables were tested to identify significant exposures. Data on outbreak management, infection prevention and control (IPC) interventions and human resources (HR) management were collected.

Results: A total of 242 neonates were admitted during the outbreak period: 44 cases and 153 controls. The incidence rate of ESBL-KP BSI was 29.7 per 1000 patient-days. Mortality among cases was 3.5 times higher (p < 0.0001). Twenty-five cases (56.8%) had early sepsis (sepsis suspected < = 3 days of hospitalisation). Case-control analysis identified maternal risk factors for neonatal infection as the most important independent risk factor. The neonatology unit occupancy rate exceeded 100% in early October, and IPC assessments revealed poor adherence to IPC measures at the beginning of the outbreak. A series of IPC interventions in the first month of the outbreak successfully controlled further spread of the infection, and the outbreak was declared over in approximately two months.

Conclusion: The ESBL-KP NICU outbreak reveals gaps in hospital management, with ESBL-KP probably spreading due to high occupancy rate, poor IPC standards, and possibly by multiple simultaneous sources. Access to microbiology and the implementation of IPC practical interventions are critical to identifying and managing outbreaks in LIC.