Extended spectrum Beta-Lactamase-producing Klebsiella pneumoniae septicaemia outbreak in the Neonatal Intensive Care Unit of a tertiary hospital in Nigeria

Abstract

Between March and August 2002 a cluster of nosocomial septicaemia associated with Extended Spectrum beta lactamase (ESBL)-producing Klebsiella pneumoniae was observed in 11 neonates from the neonatal intensive care unit of a 200-bed tertiary hospital in Abuja, the Federal Capital territory of Nigeria. An investigation was conducted to identify the possible reservoirs and mode of transmission. Infection control measures and epidemiologic surveillance were executed. The environment was investigated by collecting and processing several swab samples for microbiological studies. Antibiogram tests and extended spectrum beta lactamase production test were performed on all K. pneumoniae isolates from both the environment and the patients, and all bacteraemic and environmental isolates of K. pneumoniae compared. A total of 30 K. pneumoniae isolates made up of 17 from the patients and 13 from the environment were analysed. An identical antibiogram was found in 24 isolates, which included all the 17 from the patients and the 7 from the hands of staff, sink and incubator surface in the NICU. Mortality rate from the outbreak was 36.4% and constituted 10.8% of all deaths in the unit in 2002. Overall mortality in the unit for 2002 was 28.9%. The outbreak significantly caused more deaths than usual in the unit. The nosocomial septicaemia was caused by a single ESBL-producing strain of K. pneumnoniae brought into the hospital by a neonate delivered and admitted from an external health institution. Sink and the incubator were also contaminated by the same strain.