Contrasting Outbreak Dynamics in Inborn and Outborn Neonatal Intensive Care Units: Insights from Multidrug-resistant Klebsiella pneumoniae and Candida guilliermondii Outbreaks in NICUs in a Tertiary Care Hospital in Central India.

INTRODUCTION: This study investigates the microbiological, clinical, and epidemiological characteristics of two healthcare-associated infection clusters: multidrug-resistant Klebsiella pneumoniae in the inborn NICU and Candida guilliermondii in the outborn NICU, and evaluates the associated risk factors and infection prevention and control (IPC) measures implemented to control them METHODS: Clinical and environmental samples obtained during the investigation were processed using standard microbiological procedures. Species identification was performed using a biochemical panel and confirmed with the VITEK-2 Compact and MALDI-TOF-MS. Microbiological findings, clinical characteristics, and outbreak patterns were analyzed. RESULTS: A total of 21 neonates were affected during the K. pneumoniae outbreak, and 5 during the C. guilliermondii outbreak. Most affected neonates were preterm, low birth weight, and had prior exposure to broad-spectrum antibiotics and invasive devices. The temporal and epidemiological characteristics of K. pneumoniae cases suggested a propagated pattern, whereas those of C. guilliermondii cases suggested a localized common-source pattern. Environmental surveillance identified contamination of IV saline syringe pumps and hubs associated with specific cradles in the K. pneumoniae outbreak, with C. guilliermondii isolated from an implicated cradle in the outborn NICU. Both outbreaks were successfully managed after implementing IPC practices. CONCLUSION: This study concludes that managing outbreaks in NICUs, despite their complexities, relies on prompt identification, thorough investigations to identify infection sources and risk factors, and reinforcement of routine IPC measures.