An Outbreak of Multidrug-Resistant Klebsiella pneumoniae at a Referral Hospital in Rural Gambia

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Introduction Klebsiella pneumoniae has emerged as a critical global health threat due to its increasing multidrug resistance (MDR) and capacity to cause invasive infections. Between January 2023 and March 2024, we experienced an outbreak of invasive K. pneumoniae at a Referral Hospital in rural Gambia, which predominantly affected neonates, highlighting significant gaps in infection prevention practices.Methods An outbreak investigation was conducted at the hospital to identify sources of K. pneumoniae contamination. The key areas assessed included intravenous fluid preparation, hand hygiene, ward overcrowding, and environmental sanitation. Targeted interventions addressed the identified issues, such as improving hand hygiene practices and sanitation protocols.Results During the study period, 76 cases of invasive K. pneumoniae were identified, with 57 cases (75%) occurring in neonates. Among the clinical isolates, 64 (84%) exhibited MDR, and 74% of these isolates were resistant to three or more antimicrobials from six distinct classes. The fatality rate of the outbreak was 56%.Discussion This highlights the severe impact of K. pneumoniae infections in low-resource settings, with significant morbidity and mortality, particularly in neonates. Efforts to improve the proper preparation of medications and environmental sanitation are essential steps towards reducing future outbreaks. Strengthening the infection prevention and control infrastructure in low-resource settings remains critical for combating MDR organisms and improving patient outcomes.

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