PDF(Pubmed)
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.
摘要：
在南非一家医院的新生儿病房中，耐碳青霉烯类肺炎克雷伯菌（CRKP）血流感染和相关死亡增加后，我们在2019年10月至2020年2月期间进行了疫情调查，并在2020年3月至2021年5月期间进行了横断面随访。我们使用基因组和流行病学数据来重建爆发相关克隆的传播网络。我们记录了31例培养证实的CRKP感染和14例死亡。两个爆发相关克隆（blaNDM-1序列类型[ST]152[n=16]和blaOXA-181ST307[n=6]）共同传播。主要克隆blaNDM-1ST152占9/14（64％）的死亡人数。传输网络分析确定了2019年10月blaOXA-181ST307和2019年11月blaNDM-1ST152的可能指标案例。在后续期间,诊断出11例新的CRKP感染病例；我们没有进行基因组分析。持续的感染预防和控制措施，足够的人员配备，遵守床位占用限制，和抗菌药物管理是控制此类疫情的关键干预措施。
