An outbreak of multidrug resistant organisms in a neonatal intensive care unit in Malaysia.

Associate Professor  Sasheela Ponnampalavanar1, Dr  Azanna  Ahmad Kamar1, Ms Rosliza  Zhazali1, Ms Harvinderjit Kaur  Basauhra Singh1, Ms Mastura  Mohd Musa1, Professor Adeeba Kamarulzaman1

1University Malaya Medical Centre, Lembah Pantai, Malaysia


Multi-drug resistant organisms (MDRO) often instigate severe adverse complications and are increasingly challenging to treat in the neonatal intensive care unit (NICU). Between January–February 2017, a discernible increase in isolation of MDRO, especially of MDR Acinetobacter baumanii (MDR-AB) were noted from clinical and screening samples of infants in a 25-bed level III tertiary NICU.


An outbreak investigation was performed with concurrent assessment of infection control measures. Intensive surveillance of clinical isolates, screening of contacts and the environment was carried out. A review of protocols and practices was conducted.


Nine preterm infants [27-35 weeks gestational age, weight 540-1730 grams], were colonised or infected with a total of 13 MDRO isolated. All 13 neonates harboured MDR-AB.  Three of them also had ESBL Klebsiella pneumoniae (ESBL-KP) and one infant had carbapenem resistant K.pneumoniae (CRE-KP) with MDR-AB. MDR-AB was isolated from blood, tracheal aspirates and other sites. Four infants were infected with MDR-AB; 2 had bacteraemia and 2 had nosocomial pneumonia. Both with bacteraemia died. Surveillance culture revealed MDRO in expressed breast milk (EBM), hands of health care workers and inanimate objects such as syringe drivers and the milk room sink. Preventive interventions including geographical cohorting, re-emphasizing hand hygiene compliance, reviewing milk-handling practices and disinfection of equipment as well as the environment, resulted in no further MDRO isolated.


The spread of MDRO was suspected to have arisen from contaminated breast milk and pathogen transmission via close contact. Prompt outbreak recognition, and rigorous infection control enforcement, resulted in outbreak containment.


Dr. Sasheela  Ponnampalavanar is currently a Consultant Infectious Disease Physician and an Associate Professor of Medicine at University Malaya. She is of  Head of Infection Control Department  and chairperson of the Antibiotic Stewardship Committee.

She has a Certificate in Travel Health Medicine from the International Society of Travel Health Medicine.

She manages patients with  tropical diseases, health care associated infection and  HIV.  She has served on the committee that developed the Malaysian guidelines for treatment of Dengue, HIV and and National antibiotic guidelines.

She participates in clinical and translational research and has published in local and international peer reviewed journals.

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