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Review
. 2023 Aug;29(8):1531-1539.
doi: 10.3201/eid2908.230484.

Outbreak of NDM-1- and OXA-181-Producing Klebsiella pneumoniae Bloodstream Infections in a Neonatal Unit, South Africa

Rindidzani E Magobo, Husna Ismail, Michelle Lowe, Wilhelmina Strasheim, Ruth Mogokotleng, Olga Perovic, Stanford Kwenda, Arshad Ismail, Manala Makua, Abram Bore, Rose Phayane, Harishia Naidoo, Tanya Dennis, Makhosazane Ngobese, Wim Wijnant, Nelesh P Govender; for Baby GERMS-SA1
Review

Outbreak of NDM-1- and OXA-181-Producing Klebsiella pneumoniae Bloodstream Infections in a Neonatal Unit, South Africa

Rindidzani E Magobo et al. Emerg Infect Dis. 2023 Aug.

Abstract

After an increase in carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections and associated deaths in the neonatal unit of a South Africa hospital, we conducted an outbreak investigation during October 2019-February 2020 and cross-sectional follow-up during March 2020-May 2021. We used genomic and epidemiologic data to reconstruct transmission networks of outbreak-related clones. We documented 31 cases of culture-confirmed CRKP infection and 14 deaths. Two outbreak-related clones (blaNDM-1 sequence type [ST] 152 [n = 16] and blaOXA-181 ST307 [n = 6]) cocirculated. The major clone blaNDM-1 ST152 accounted for 9/14 (64%) deaths. Transmission network analysis identified possible index cases of blaOXA-181 ST307 in October 2019 and blaNDM-1 ST152 in November 2019. During the follow-up period, 11 new cases of CRKP infection were diagnosed; we did not perform genomic analysis. Sustained infection prevention and control measures, adequate staffing, adhering to bed occupancy limits, and antimicrobial stewardship are key interventions to control such outbreaks.

Keywords: Klebsiella pneumoniae; South Africa; bacteria; blaNDM; blaOXA-181; carbapenem-resistance; healthcare-associated outbreaks; neonates; whole-genome sequencing.

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Figures

Figure 1
Figure 1
Number of cases of bloodstream infection for 3 common bacterial pathogens (n = 428) and number of admissions (n = 5,796) in the neonatal unit during baseline period, South Africa, January 2017–September 2019. Black data line indicates number of admissions. Scales for the y-axes differ substantially to underscore patterns but do not permit direct comparisons.
Figure 2
Figure 2
Epidemic curve of 31 cases of carbapenem-resistant Klebsiella pneumoniae bloodstream infection by date of specimen collection and ST of isolate during outbreak period, South Africa, October 2019–February 2020. ST, sequence type.
Figure 3
Figure 3
Reference laboratory antimicrobial susceptibility profiles of 27 viable Klebsiella pneumoniae isolates from cases of bloodstream infection during a neonatal unit outbreak, South Africa, October 2019–February 2020.
Figure 4
Figure 4
Transmission networks among 22 patients with outbreak-associated blaOXA-181 sequence type 307 (A) and blaNDM-1 sequence type 152 (B) clones of Klebsiella pneumoniae isolated from a neonatal unit during outbreak, South Africa, October 2019–February 2020. Question marks denote missing isolates; numbers along branches indicate number of single-nucleotide polymorphisms between index isolate and other isolates.
See this image and copyright information in PMC

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