Phased outbreak of Burkholderia cepacia complex and multi-drug resistant Klebsiella pneumoniae causing neonatal sepsis in a tertiary hospital in Benin City, Nigeria: Investigation and mitigation

Document Type : Original Article

Authors

1 Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin City, Nigeria

2 Infection Prevention and Control Committee, University of Benin Teaching Hospital, Benin City, Nigeria

3 Medical Microbiology Department, University of Benin Teaching Hospital, Benin City, Nigeria

4 Department of Public health and Community Medicine, University of Benin Teaching Hospital, Nigeria

5 Department of Child Health, University of Benin Teaching Hospital, Benin City, Nigeria

Abstract

Background:  Burkholderia cepacia complex (Bcc) is an emerging pathogen known to contaminate pharmaceutical solutions and medical devices, but has largely been underreported as causing infections in Nigeria. This study presents detailed microbiological and environmental surveillance activities of a sequential outbreak of Bcc and extended-spectrum beta-lactamase (ESßL)-producing Klebsiella pneumoniae causing neonatal sepsis in a tertiary hospital in Benin City, Nigeria.  Methods: Blood culture requests were made for neonates upon clinical suspicion of sepsis. Blood specimens were collected in duplicates in BactT/Alert bottles and incubated in the BacT/Alert machine. Further processing of culture-positive bottles was carried out. Identification and antimicrobial susceptibility tests (AST) of emergent organisms were carried out using the VITEK-2 COMPACT system. Environmental surveillance was also done following standard guidelines. Results: During the study period, a total of 303 blood culture requests were received out of which 101 (33.3%) yielded growth of Gram-negative bacilli. Thirty-three (10.9%) yielded Bcc and 41(13.7%) yielded K. pneumoniae (ESßL-producing). All Bcc isolates had similar AST patterns. Various samples from the medical solutions, disinfectants, and environment were negative for the Bcc and K. pneumoniae. However, Bcc and K. pneumoniae (ESßL-producing) were recovered from tap heads and sink drains. Timely infection prevention and control (IPC) interventions led to a decline in the incidence rate. Conclusion: An interplay of proper microbial identification, keen observation, and inter-professional collaboration was key in detailing the phased outbreak of Bcc and K. pneumoniae causing neonatal sepsis. The study highlights the significance of IPC measures in preventing and mitigating the spread of multidrug resistant pathogens.

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