Durban - Four babies who died in a neonatal intensive care unit at a hospital in KwaZulu-Natal in August, had contracted multi-drug resistant Acinetobacter baumannii (MDR-AB).
According to the National Institute for Communicable Diseases (NICD), the babies were in the same neonatal ICU at a hospital in the province and there were five initial cases and four babies died.
All had underlying conditions, the institute said. It said while infections were the second most common cause of neonatal deaths, the cause of death was not investigated and established.
The NICD declined to name the hospital and the KZN Health Department referred all queries back to the NICD.
Liliwe Shuping of the NICD said that MDR-AB is a bacterium germ which can be found in the environment, and can also live on surfaces in hospitals, for example on bed rails, monitors, breathing machines (or ventilators) and drip stands.
She said three of the four babies who died were under 28 weeks’ premature with birth weights of less than 1 500g. She said premature babies with such low birth weights were at high risk of death due to complications of prematurity, including birth defects such as heart malformations, breathing difficulties and asphyxia, and intraventricular haemorrhage (bleeding inside or around the ventricles in the brain).
According to Shuping, there was no definitive evidence of the source of the bacteria which infected the babies.
To control the suspected outbreak, Shuping said infection prevention and control measures were implemented in the neonatal unit, including limiting the number of new admissions to the unit, improving hand-washing practices, cleaning and decontaminating surfaces.
“After these measures were implemented, there were no additional babies with MDR-AB reported, indicating successful control,” she said.
Professor Andrew Whitelaw, a medical microbiologist in the Division of Medical Microbiology at Stellenbosch University, said in hospitals, MDR-AB could be found “colonising patients, colonising equipment, colonising various surfaces, and transiently on health-care workers’ hands”. “It spreads from person to person in the hospital most commonly by direct contact on hands, or indirect contact through equipment.”
He said the most common infections associated with the bacterium are pneumonia (usually in patients being ventilated), and infections of intravenous lines. “It is what is called an opportunistic pathogen – it typically only causes disease in people who have some form of immune compromise. This would include patients on ventilators, or patients with intravenous lines where the bacterium can use the line to access the bloodstream,” said Whitelaw.
A major concern with Acinetobacter baumannii, according to Whitelaw, is that it is frequently resistant to a large number of antibiotics.
“That is what has led to the term ‘superbug’. It is not that the bacterium causes more severe disease, or that it causes disease more easily – it refers to the fact that it is typically resistant to the majority of antibiotics,” he said.
Shuping also noted that KZN had the third highest incidence of neonatal infections in the Baby Germs surveillance conducted by the NICD, with almost 9 000 cases over six years.
“Greater awareness and advocacy for reducing neonatal infections in hospitals is one of the interventions that may help reduce these infections,” she said.