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Case study

Multidrug-resistant Klebsiella Pneumoniae outbreak in Sahloul University Hospital in Tunisia, July-August 2022

Multidrug-resistant Klebsiella Pneumoniae outbreak in Sahloul University Hospital in Tunisia, July-August 2022

Arwa Neffati1,2,&, Mouna Safer2,3, Hela Ghali1,4,5, Farah Azouzi4,5,6, Asma Ben Cheikh1,4,5, Sameh Boughattas5,6, Lamia Tilouche5,6, Mohamed Sahbi Chalbi1, Aicha Chaichi2,3, Sonia Dhaouadi2,3, Hajer Letaief2,3, Sana Bhiri1,4, Soumaya Ketata6,7, Abdelhalim Trabelsi6,7, Houyem Said Latiri1,4,5, Nissaf Bouafif Ben Alaya2,3

 

1Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia, 2National Observatory of New and Emerging Diseases, Tunisia, 3Faculty of Medicine of Tunis, University Tunis Manar, Tunis, Tunisia, 4Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia, 5LR20SP06, Sahloul University Hospital, Sousse, Tunisia, 6Microbiology Laboratory, Sahloul University Hospital, Sousse, Tunisia, 7Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia

 

 

&Corresponding author
Arwa Neffati, Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia

 

 

Abstract

On July 27th and 29th, 2022, the Prevention and Safety of Care Department at Sahloul University Hospital was alerted to an outbreak of invasive infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). The infections were reported in three departments: Post Serious Operations (PSO), Surgical Resuscitation, and Orthopedics. This case study examines the outbreak, focusing on the epidemiological investigation, environmental The teaching approach involves a systematic methodology for conducting outbreak investigations and implementing infection control strategies in a university hospital. Students will describe cases by time, person, and place, and prepare synoptic charts. They will also evaluate adherence to standard hygiene precautions and interpret data from figures and tables, leading to recommendations for corrective actions. This epidemic involved three cases of patients with intrinsic (comorbidities) and extrinsic (invasive procedures: gastrostomy, vascular catheterization, urinary catheter) risk factors. The three isolated strains had the same antibiotype characterized by resistance to all antibiotics except Fosfomycin and colistin. The environmental survey didn´t monitor any Klebsiella pneumoniae in the three patients´ environments. From the six criteria of the standard hygiene precautions, 16 observations were tested in the audit, from which (10; 62.5%) were respected in the Surgical Resuscitation department, (8; 50%) in the PSO department and (2; 12.5%) in orthopedic department. This investigation highlights the need for a proactive surveillance system and strict adherence to infection control measures to prevent the spread of CRKP.

 

 

How to use this case study    Down

General instructions: this case study should be used as adjunct training material for novice epidemiology trainees to reinforce the concepts taught in prior lectures. The case study is ideally taught by a facilitator in groups of about 20 participants. Participants are to take turns reading the case study, usually a paragraph per student. The facilitator guides the discussion on possible responses to questions. The facilitator may make use of flip charts to illustrate certain points. Additional instructor´s notes for facilitation are coupled with each question in the instructor´s guide to aid facilitation.

Audience: this case study was developed for novice field epidemiology students. These participants are commonly health care workers working in the county departments of health whose background may be as medical doctors, nurses, environmental health officers or laboratory scientists who work in public health-related fields. Most have a health science or biology background.

Prerequisites: before using this case study, participants should have received lectures on disease surveillance and outbreak investigation.

Materials needed: Flash drive, flip charts, markers, computers with MS Excel

Level of training and associated public health activity: Outbreak investigation.

Time required: 2-3 hours.

 

 

Case study material Up    Down

  • Download the case study student guide;
  • Request the case study facilitator guide.

 

 

Competing interests Up    Down

The authors declare no competing interests.

 

 

Acknowledgments Up    Down

We wish to acknowledge the Eastern Mediterranean Public Health Network (EMPHNET) for their support.

 

 

Figures Up    Down

Figure 1: description of the Orthopedic Department and the isolation room in Sahloul University Hospital

Figure 2: description of the first floor containing the operating rooms and PSO department in Sahloul University Hospital

 

 

References Up    Down

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