Our hospital is a tertiary referral centre in South Africa that manages up to 8000 high-risk deliveries per year of which 45% of newborns are of low birth weight (<2500grams). The neonatal unit has > 100 beds available to care for sick newborns (four wards and eight neonatal intensive care beds) and is mostly at full capacity. Prior to December 2018, we had only seen one case of bacteraemia caused by carbapenem-resistant Klebsiella pneumoniae, which belong to a family of bacteria called Enterobacteriaceae. However, between 1 December 2018 and 2 January 2019 we had four positive blood cultures confirming carbapenem-resistant Enterobacteriaceae (CRE) infection in newborns at our hospital; three newborns survived while one sadly died. Following these CRE infections, we declared a CRE neonatal outbreak on 3 January 2019.
CRE are Gram-negative bacteria that can give rise to serious infections. These are often resistant to commonly used antibiotics as well as carbapenem antibiotics, such as meropenem, imipenem and ertapenem, which are often used as a last resort to treat serious infections so resulting in infections that are difficult to treat. For this reason, such infections are associated with high mortality.