An Outbreak Investigation of Neonatal Sepsis Caused by Multi-drug Resistant Klebsiella Bacteria at Neonatal Intensive Care Unit, Buengkarn Hospital, 25 – 31 May 2014

Abstract

Background: On 23 May 2014, Infectious Control Unit, Buengkarn Hospital was notified by the pediatrician about a cluster of neonatal sepsis with multi-drug resistant at neonatal intensive care unit (NICU). The surveillance and rapid response teams from Preventive Medicine and Infectious Control Units joint investigated during 25 – 31 May 2014. The objectives aimed to confirmed diagnosis and outbreak, to identify the source of outbreak and to implement control and prevention measures.
Methods: We reviewed the situation and conducted active case finding in the hospital. The case definition was met a criteria of neonatal sepsis and laboratory-confirmed multi-drugs resistant strain of Klebsiella in NICU during 1-25 May 2014. Environmental survey and interviewed the staffs at NICU were done. The instruments, feeding utensils including milk and food were obtained in NICU for bacterial culture. Hand swab from staffs in NICU also done for cultures.
Results: Overall 17 cases were met criteria of neonatal sepsis. Of these 2 cases were infected with Klebsiella ( Extended spectrum beta-lactamases: ESBL-producing strain). The case’s onsets were 12 and 13 May 2014 respectively. The antimicrobial drugs susceptibility test of Klebsiella pneumoniae ESBL-producing strain between hemoculture of first case and environment was similar 75%. But the second case was poor similarly pattern (36%). The lab results of environment revealed positive on a feeding milk table, incubator and infusion pump. The contamination might occur in milk preparation for feeding the neonate. There was also poor effectiveness of boiled milk bottle due to suboptimal heat temperature and duration of contact time. After implemented control and prevention measures in the NICU, there was no additional case.
Conclusions: There was confirmed first outbreak of neonatal sepsis caused by Klebsiella ESBL-producing strain in NICU, Buengkarn Hospital on May 2014. The transmission was contaminated from the environment and poor infrastructures.