Outbreak of NDM-1– and OXA-181–Producing Klebsiella pneumoniae Bloodstream Infections in a Neonatal Unit, South Africa

After an increase in carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections and associated deaths in the neonatal unit of a South Africa hospital, we conducted an outbreak investigation during October 2019–February 2020 and cross-sectional follow-up during March 2020–May 2021. We used genomic and epidemiologic data to reconstruct transmission networks of outbreak-related clones. We documented 31 cases of culture-confirmed CRKP infection and 14 deaths. Two outbreak-related clones (bla(NDM-1) sequence type [ST] 152 [n = 16] and bla(OXA-181) ST307 [n = 6]) cocirculated. The major clone bla(NDM-1) ST152 accounted for 9/14 (64%) deaths. Transmission network analysis identified possible index cases of bla(OXA-181) ST307 in October 2019 and bla(NDM-1) ST152 in November 2019. During the follow-up period, 11 new cases of CRKP infection were diagnosed; we did not perform genomic analysis. Sustained infection prevention and control measures, adequate staffing, adhering to bed occupancy limits, and antimicrobial stewardship are key interventions to control such outbreaks.