Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae and multidrug-resistant Acinetobacter baumannii in the neonatal intensive care unit, Dr Soetomo General Hospital, Indonesia: A case series

Nosocomial outbreaks caused by Extended-Spectrum Beta-Lactamase (ESBL) producing Klebsiella pneumoniae strains and Multi-Drug-Resistant (MDR) Acinetobacter baumannii have been described by many authors but never from our region. Klebsiella pneumoniae is the commonest cause of Neonatal Intensive Care Unit (NICU) outbreaks and potentially causes morbidity and mortality as a hospital-acquired pathogen1. The newborn immune system is still immature, making it more prone to infections as well as Low Birth Weight (LBW), and the frequent use of invasive devices and antibiotics2. A study from Bosnia found a 35.3% neonatal mortality rate (NMR) from MDR Acinetobacter baumannii, while some studies reported NMRs between 22% and 83%3. We report an outbreak of ESBL producing Klebsiella pneumoniae strains concurrent with MDR Acinetobacter baumannii in the NICU of Dr Soetomo General Hospital, Indonesia. We describe the Hospital Acquired Infection (HAI) caused by Klebsiella pneumoniae and Acinetobacter baumannii and the control measure from the NICU outbreak to interrupt the chain of transmission.