Outbreak of extended-spectrum beta lactamase klebsiella pneumoniae in an MSF supported maternity in Central African Republic

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INTRODUCTION: in March 2017, an outbreak of klebsiella pneumoniae extended-spectrum beta lactamase (ESBL-KP), was reported at the neonatal unit of the Médecins Sans Frontières-supported maternity in Bangui, Central African Republic. A comprehensive outbreak response was implemented to identify and control the potential sources. The response consisted of clinical case identification, management, epidemiological investigation, laboratory support, and infection prevention and control (IPC). We present the characteristics of the outbreak, treatment adaptation, IPC measures and the lessons learnt. METHODS: we defined suspected ESBL-KP cases as neonates born at the maternity and admitted to the neonatal unit with suspected sepsis not responding to first line antibiotics. Case confirmation was done by hemocultures undertaken from all suspected neonates with their related antimicrobial susceptibility patterns. An environmental investigation was conducted. RESULTS: by August 10th, 25 confirmed cases of ESBL-KP were reported, with a 28% case fatality rate (n = 7). The main symptoms in confirmed cases were fever, jaundice and respiratory distress. 52% showed an onset of symptoms in the 72 hours after birth (n = 13). Antibiotic susceptibility testing showed 100% resistance to ampicillin, gentamicin, cefotaxime and ceftriaxone. The second line treatment changed from mid-March to late-April from ampicillin and cefotaxime to amikacin and/or imipenem/meropenem with subsequent de-escalation to the standard protocol. IPC interventions focused on strengthening standard precautions (hand hygiene, cleaning and disinfection of the environment and reprocessing of reusable medical equipment), implementation of wet wipes for newborn hygiene, reorganization, and infection prevention in the care. ESBL-KP was isolated from sinks, but was not found in water samples. CONCLUSION: an outbreak of multi-resistant ESBL-KP was detected at the maternity due to strengthened surveillance. Surveillance has been maintained in order to rapidly identify new peaks. Nosocomial transmission likely occurred. Improvement of IPC standards, staff sensitization and training were recommended to avoid new outbreaks.

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