Investigation of Klebsiella pneumonia and Acinetobacter baumannii Outbreak at a Secondary Care Hospital in Saudi Arabia

Semaa M al radhwan¹, Eman barnawi^1, , Atef M. shibl², Omar Alharbi¹, Majed Al mograbi¹, Ateeq al garni¹ and Nasser Al-shanbari¹

¹Ministry of Health-Saudi Arabia, Riyadh, Saudi Arabia

²Department of microbiology, Alfaisal university, college of medicine

Cite this paper:
Semaa M al radhwan, Eman barnawi, Atef M. shibl, Omar Alharbi, Majed Al mograbi, Ateeq al garni and Nasser Al-shanbari. Investigation of Klebsiella pneumonia and Acinetobacter baumannii Outbreak at a Secondary Care Hospital in Saudi Arabia. American Journal of Infectious Diseases and Microbiology. 2024; 12(1):1-8. doi: 10.12691/ajidm-12-1-1

Abstract

Background: Carbapenem-resistant Acinetobacter baumannii (A. baumannii) and Klebsiella pneumonia (K. pneumonia) are accused of high prevalence and ability to cause outbreaks in healthcare settings. The current work aimed to analyze one of the major K. pneumonia and A. baumannii outbreaks at a secondary care hospital in Riyadh, Saudi Arabia including the identification of patients’ infectivity and mortality risk factors, antibiotic susceptibility test results of the bacterial isolates, and infection control measures employed to halt the outbreak. Methods: A cross-sectional study was conducted from February to August 2022. Data were collected from the General Directorate of Infection Prevention and Control, Saudi Ministry of Health, and analysed using SPSS version 27. Results: 50 cases were affected by the outbreak, either infected with K. pneumonia or A. baumannii or co-infected with both organisms. Risk factors for particular infection among affected patients were the underlying diseases (p=0.026), length of pre-infection stay (p=0.004), and ICU stay (p=0.015). A. baumannii-infected patients have higher mortality rates (70.0%). K. pneumonia and A. baumannii demonstrate low sensitivity to 4 tested antibiotics including Amikacin, Gentamicin, trimethoprim-sulfamethoxazole, and Tigecycline, the last resort antibiotic treatment. Conclusion: K. pneumonia and A. baumannii outbreaks were associated with a preventable clinical and financial burden. Active screening of healthcare-associated infections is crucial for early detection, successful management of infection, and prevention of outbreak occurrence. Infection control measures played a significant role in controlling the outbreak.

Keywords:
Acinetobacter baumannii Klebsiella pneumonia outbreak infection control mortality

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References:

[1]	Chhatwal, P., Ebadi, E., Schwab, F., Ziesing, S., Vonberg, R. P., Simon, N., et al. Epidemiology and infection control of carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae at a German university hospital: a retrospective study of 5 years (2015–2019). BMC Infect Dis. 2021 Dec 1; 21(1).
[2]	Klebsiella pneumoniae in Healthcare Settings | HAI | CDC [Internet]. [cited 2022 Sep 27]. Available from: https://www.cdc.gov/hai/organisms/klebsiella/klebsiella.html.
[3]	Perez, F., Endimiani, A., Ray, A. J., Decker, B.K., Wallace, C.J., Hujer, K. M., et al. Carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae across a hospital system: Impact of post-acute care facilities on dissemination. Journal of Antimicrobial Chemotherapy. 2010 May 31; 65(8): 1807–18.
[4]	Costa, D.M., Johani, K., Melo, D.S., Lopes, L.K.O., Lopes Lima, L.K.O., Tipple, A.F.V., Hu, H. and Vickery, K., 2019. Biofilm contamination of high‐touched surfaces in intensive care units: epidemiology and potential impacts. Letters in applied microbiology, 68(4), pp.269-276.
[5]	Zhou, K., Xiao, T., David, S., Wang, Q., Zhou, Y., Guo, L., Aanensen, D., Holt, K.E., Thomson, N.R., Grundmann, H. and Shen, P., 2020. Novel subclone of carbapenem-resistant Klebsiella pneumoniae sequence type 11 with enhanced virulence and transmissibility, China. Emerging infectious diseases, 26(2), p.289.
[6]	Tracking CRE in the United States| HAI | CDC [Internet]. [cited 2022 Oct 11]. Available from: https://www.cdc.gov/hai/organisms/cre/trackingcre.html.
[7]	Alothman, A., Al Thaqafi, A., Al Ansary, A., Zikri, A., Fayed, A., Khamis, F., Al Salman, J., Al Dabal, L., Khalife, N., AlMusawi, T. and Alfouzan, W., 2020. Prevalence of infections and antimicrobial use in the acute-care hospital setting in the Middle East: Results from the first point-prevalence survey in the region. International Journal of Infectious Diseases, 101, pp.249-258.
[8]	Alfouzan, W., Dhar, R., Abdo, N.M., Alali, W.Q. and Rabaan, A.A., 2021. Epidemiology and microbiological profile of common healthcare associated infections among patients in the intensive care unit of a general hospital in Kuwait: a retrospective observational study. Journal of epidemiology and global health, 11(3), p.302.
[9]	Ibrahim, S., Al-Saryi, N., Al-Kadmy, I.M. and Aziz, S.N., 2021. Multidrug-resistant Acinetobacter baumannii as an emerging concern in hospitals. Molecular biology reports, 48(10), pp.6987-6998.
[10]	Global report on infection prevention and control [Internet]. 2022. Available from: http://apps.who.int/bookorders.
[11]	Taati Moghadam, M., Khoshbayan, A., Chegini, Z., Farahani, I. and Shariati, A., 2020. Bacteriophages, a new therapeutic solution for inhibiting multidrug-resistant bacteria causing wound infection: lesson from animal models and clinical trials. Drug design, development and therapy, pp.1867-1883.
[12]	Xie, R., Zhang, X.D., Zhao, Q., Peng, B. and Zheng, J., 2018. Analysis of global prevalence of antibiotic resistance in Acinetobacter baumannii infections disclosed a faster increase in OECD countries. Emerging microbes & infections, 7(1), pp.1-10.
[13]	WHO publishes list of bacteria for which new antibiotics are urgently needed [Internet]. [cited 2023 Apr 2]. Available from: https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed.
[14]	Martín-Aspas, A., Guerrero-Sánchez, F.M., García-Colchero, F., Rodríguez-Roca, S. and Girón-González, J.A., 2018. Differential characteristics of Acinetobacter baumannii colonization and infection: risk factors, clinical picture, and mortality. Infection and drug resistance, 11, p.861.
[15]	Jiao, Y., Qin, Y., Liu, J., Li, Q., Dong, Y., Shang, Y., Huang, Y. and Liu, R., 2015. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection/colonization and predictors of mortality: a retrospective study. Pathogens and global health, 109(2), pp.68-74.
[16]	Said, K.B., Alsolami, A., Moussa, S., Alfouzan, F., Bashir, A.I., Rashidi, M., Aborans, R., Taha, T.E., Almansour, H., Alazmi, M. and Al-Otaibi, A., 2022. COVID-19 clinical profiles and fatality rates in hospitalized patients reveal case aggravation and selective co-infection by limited gram-negative bacteria. International journal of environmental research and public health, 19(9), p.5270.
[17]	Wang, Z., Qin, R.R., Huang, L. and Sun, L.Y., 2018. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection and mortality of Klebsiella pneumoniae infection. Chinese medical journal, 131(01), pp.56-62.
[18]	AliMohammadi, A., Chezani-Sharahi, N., Hezaveh, Z.A., Abbasi, E., Shariati, A. and Ghaznavi-Rad, E., 2023. The significant role of Carbapenems-resistant Acinetobacter Baumannii in mortality rate of patients with COVID-19. Vacunas, 24(1), pp.13-18.
[19]	Wu, C., Zheng, L. and Yao, J., 2022. Analysis of risk factors and mortality of patients with carbapenem-resistant Klebsiella pneumoniae infection. Infection and Drug Resistance, pp.2383-2391.
[20]	Alqahtani, A.N., Almaghrabi, R.H., Albaadani, M.M. and Almossa, K., 2020. Impact of infection control training program in improving the quality of healthcare. European Journal of Medical and Health Sciences, 2(5).
[21]	Cano, A., Gutiérrez-Gutiérrez, B., Machuca, I., Gracia-Ahufinger, I., Pérez-Nadales, E., Causse, M., Castón, J.J., Guzman-Puche, J., Torre-Giménez, J., Kindelán, L. and Martínez-Martinez, L., 2018. Risks of infection and mortality among patients colonized with Klebsiella pneumoniae carbapenemase–producing K. pneumoniae: Validation of Scores and Proposal for Management. Clinical Infectious Diseases, 66(8), pp.1204-1210.
[22]	Alrahmany, D., Omar, A.F., Alreesi, A., Harb, G. and Ghazi, I.M., 2022. Acinetobacter baumannii infection-related mortality in hospitalized patients: Risk factors and potential targets for clinical and antimicrobial stewardship interventions. Antibiotics, 11(8), p.1086.
[23]	Gottesman, T., Fedorowsky, R., Yerushalmi, R., Lellouche, J. and Nutman, A., 2021. An outbreak of carbapenem-resistant Acinetobacter baumannii in a COVID-19 dedicated hospital. Infection prevention in practice, 3(1), p.100113.
[24]	Chen, C.H., Lin, L.C., Chang, Y.J., Chen, Y.M., Chang, C.Y. and Huang, C.C., 2015. Infection control programs and antibiotic control programs to limit transmission of multi-drug resistant Acinetobacter baumannii infections: evolution of old problems and new challenges for institutes. International journal of environmental research and public health, 12(8), pp.8871-8882.