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Kim S, Jung S, Lee DH, Chang CL, Bae M, Kim AR, Lee SJ, Lim S. Outbreak investigation of Serratia marcescens bloodstream infection in an obstetric ward for high-risk pregnant women. BMC Infect Dis 2024; 24:266. [PMID: 38418981 PMCID: PMC10900556 DOI: 10.1186/s12879-024-09134-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Serratia marcescens is a gram-negative bacterium that is widespread in the environment. S. marcescens bacteremia can be fatal during pregnancy and cause persistent chorioamnionitis. This study reports an outbreak of Serratia marcescens bloodstream infection (BSI) among high-risk pregnant women in an obstetric ward. The purpose of this study is to report our experience with the usefulness of the ATP test in hospital environmental management and to confirm that bloodstream infections of patients with the same strain were correlated by WGS testing. METHODS This retrospective study collected the data of inpatients with S. marcescens bacteremia in obstetric ward for high-risk pregnant women from August 22, 2021, to October 14, 2021. We performed: an adenosine triphosphate (ATP) bioluminescence test in the environment with a high-contact area; environmental culture; on-site monitoring and staff education; and whole-genome sequencing (WGS) to evaluate genetic relationships among S. marcescens isolates. RESULTS S. marcescens BSI occurred in four consecutive patients. None of the patients had central venous catheters. An ATP bioluminescence test revealed that high-contact areas and areas for injection preparation were not clean (≥ 1000 relative light units). However, S. marcescens was not identified in the environmental cultures, likely due to intensive environmental cleaning and discarding of potentially contaminated specimens before the culture test. On-site monitoring and education were conducted for 1 month. There were no further reports of BSI until 6 months after the last patient was discharged. WGS performed on three isolates from three patients indicated that the isolated S. marcescens was likely from the same strain. CONCLUSIONS We controlled an S. marcescens outbreak by improving environmental cleaning as well as education of and behavior changes in healthcare workers. Using the ATP bioluminescence test can provide feedback on environmental cleaning and education. WGS played a role in determining the spread of BSI caused by the same strain.
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Affiliation(s)
- Seulki Kim
- Department of Internal Medicine, Division of Infectious Diseases, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sunah Jung
- Infection Prevention Department, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong Hyung Lee
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Obstetrics & Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Chulhun L Chang
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Moonsuk Bae
- Department of Internal Medicine, Division of Infectious Diseases, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - A Reum Kim
- Department of Internal Medicine, Division of Infectious Diseases, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Su Jin Lee
- Department of Internal Medicine, Division of Infectious Diseases, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Seungjin Lim
- Department of Internal Medicine, Division of Infectious Diseases, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea.
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
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Bizubac M, Balaci-Miroiu F, Filip C, Vasile CM, Herișeanu C, Marcu V, Stoica S, Cîrstoveanu C. Neonatal Brain Abscess with Serratia marcescens after Intrauterine Infection: A Case Report. Antibiotics (Basel) 2023; 12:antibiotics12040722. [PMID: 37107084 PMCID: PMC10135221 DOI: 10.3390/antibiotics12040722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Brain abscesses are a possible complication of bacterial sepsis or central nervous system infection but are uncommon in the neonatal period. Gram-negative organisms often cause them, but Serratia marcescens is an unusual cause of sepsis and meningitis in this age group. This pathogen is opportunistic and frequently responsible for nosocomial infections. Despite the existing antibiotics and modern radiological tools, mortality and morbidity remain significant in this group of patients. We report an unusual unilocular brain abscess in a preterm neonate caused by Serratia marcescens. The infection had an intrauterine onset. The pregnancy was achieved through assisted human reproduction techniques. It was a high-risk pregnancy, with pregnancy-induced hypertension, imminent abortion, and required prolonged hospitalization of the pregnant woman with multiple vaginal examinations. The infant was treated with multiple antibiotic cures and percutaneous drainage of the brain abscess associated with local antibiotic treatment. Despite treatment, evolution was unfavorable, complicated by fungal sepsis (Candida parapsilosis) and multiple organ dysfunction syndrome.
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Affiliation(s)
- Mihaela Bizubac
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Francisca Balaci-Miroiu
- Neonatal Intensive Care Unit, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Cristina Filip
- Department of Pediatrics, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Cardiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Corina Maria Vasile
- Department of Pediatric Cardiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
| | - Carmen Herișeanu
- Neonatal Intensive Care Unit, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
- Ph.D. School Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Veronica Marcu
- Department of Radiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Sergiu Stoica
- Department of Neurosurgery, Monza Hospital, 021967 Bucharest, Romania
| | - Catalin Cîrstoveanu
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
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Park SY, Kim MJ, Park S, Kim NI, Oh HH, Kim J. Chorioamnionitis caused by Serratia marcescens in a healthcare worker: A case report. World J Clin Cases 2021; 9:5689-5694. [PMID: 34307626 PMCID: PMC8281411 DOI: 10.12998/wjcc.v9.i20.5689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/07/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are at an increased risk for exposure to infections. Serratia marcescens (S. marcescens) is a gram-negative, opportunistic and nosocomial pathogen belonging to the Enterobacterieae family. A few case reports have been published of chorioamnionitis caused by S. marcescens infection. Immunological changes during pregnancy can also affect the risk of infection. However, few studies have examined hospital-acquired bacterial infection in pregnant HCWs.
CASE SUMMARY A 33-year-old woman, a resident in anesthesiology, was admitted at 14 wk gestation for fever with chills. She had no medical history other than contact dermatitis of both hands that started from the beginning of the trainee. There was no obvious infection focus and no bacterial growth in blood cultures. She was discharged after 1 wk of empirical antibiotic treatment. At three weeks before the fever started, she had a blister on the site of contact dermatitis on both hands, she applied antibiotic ointment for three days and the blisters had healed. At 19 wk gestation, she had a high fever and was readmitted. Physical examination and image studies were nonspecific and the patient had no other symptoms. S. marcescens grew in blood cultures at 19 wk gestation. Treatment with intravenous antibiotics was started. However, she suffered a miscarriage at 224/7 wk gestation. Pathologically, the amniotic membrane showed chorioamnionitis with a focal infarct. Subsequently, a placenta tissue culture grew S. marcescens.
CONCLUSION HCWs can be exposed to pathogens that can cause opportunistic infections such as S. marcescens. Pregnancy affects the immune system, making it susceptible to opportunistic infections. Therefore, pregnant HCWs may require more preventive measures, including hand hygiene and avoid risk factors (ex. wrapping the skin).
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Affiliation(s)
- Sue Youn Park
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju 61469, South Korea
| | - Min Ji Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju 61469, South Korea
| | - Sanghee Park
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju 61469, South Korea
| | - Nah Ihm Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju 61469, South Korea
| | - Hyung Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, South Korea
| | - Joungmin Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju 61469, South Korea
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Ottolini KM, Litke-Wager CA, Johnson RL, Schulz EV. Serratia Chorioamnionitis and Culture Proven Sepsis in a Preterm Neonate: A Case Report and Review of the Literature. Pediatr Infect Dis J 2021; 40:e62-e65. [PMID: 33093431 DOI: 10.1097/inf.0000000000002962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Serratia marcescens is a well-known cause of nosocomial infectious outbreaks in the neonatal intensive care unit, with a high mortality rate in the vulnerable preterm population. However, it is not typically associated with neonatal sepsis secondary to intrapartum vertical transmission. We present the case of a preterm male born at 25 weeks and 4 days of gestation in Okinawa, Japan with culture-proven S. marcescens chorioamnionitis and sepsis, as well as a review of the previously published literature. METHODS We conducted a literature search utilizing MeSH indexing with the headings [chorioamnionitis], [Serratia], and [infant, newborn] limited to "humans" with a publication date range between 1950 and 2020. RESULTS All reported cases of preterm S. marcescens chorioamnionitis occurred in coastal locations. The majority of cases resulted in spontaneous abortion, and we found no published reports of confirmed S. marcescens chorioamnionitis in conjunction with viable preterm delivery and positive neonatal cultures. In the case presented herein, S. marcescens chorioamnionitis with associated neonatal sepsis was confirmed by positive placental and blood cultures. Bacterial clearance was achieved following an antibiotic course consisting of 5 days of gentamicin and 14 days of meropenem therapy. CONCLUSIONS S. marcescens is an uncommon cause of chorioamnionitis that can have devastating neonatal consequences, especially in the at-risk preterm population.
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Affiliation(s)
- Katherine M Ottolini
- From the Department of Neonatology, 18th Medical Operations Squadron, Kadena AB, Okinawa, Okinawa, Japan
- Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, Maryland
| | - Carrie A Litke-Wager
- From the Department of Neonatology, 18th Medical Operations Squadron, Kadena AB, Okinawa, Okinawa, Japan
- Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, Maryland
| | - Rebecca L Johnson
- Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, Maryland
| | - Elizabeth V Schulz
- From the Department of Neonatology, 18th Medical Operations Squadron, Kadena AB, Okinawa, Okinawa, Japan
- Department of Pediatrics, Division of Neonatology, Uniformed Services University, Bethesda, Maryland
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Kljakić D, Milosavljević MZ, Jovanović M, Popović VČ, Raičević S. Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy. Open Med (Wars) 2020; 16:81-86. [PMID: 33385065 PMCID: PMC7754176 DOI: 10.1515/med-2021-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/18/2020] [Accepted: 11/20/2020] [Indexed: 12/04/2022] Open
Abstract
Several Serratia species are widely distributed in nature, but Serratia marcescens is the only species frequently isolated in hospitals. This pathogen is mainly responsible for nosocomial infection, mostly in immunocompromised hosts. A 26-year-old woman with a twin pregnancy, regularly controlled, was hospitalized at 24 + 5 weeks of gestation due to scant vaginal bleeding, lower abdominal pain, and body temperature up to 37.5°C. Gynecological examination revealed bleeding accompanied by dilatation of the cervix. The laboratory analyses revealed leukocytosis with elevated C-reactive protein (CRP). Treatment was initiated with intravenous antibiotic administration. After admission, fetal membranes spontaneously ruptured, and an extremely preterm dichorionic female twin birth occurred at 25 + 0 weeks of gestation. Both infants died two days after labor. Pathological and microbiological analyses revealed chorioamnionitis caused by S. marcescens. According to the antibiogram, antibiotic treatment was continued for the next 7 days. The examination of cervical and vaginal discharge samples was negative three days and two weeks after therapy. S. marcescens may cause spontaneous miscarriages and, in this important case, caused loss of discordant twins in an extremely preterm birth by an immunocompetent patient. Infection by S. marcescens cannot be excluded as a cause of discordant growth and needs to be confirmed by further research.
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Affiliation(s)
- Duško Kljakić
- Department of Gynecology, General Hospital Bar, Bar, Montenegro
| | | | - Milan Jovanović
- Clinic for Infectious Diseases, Clinical Center of Montenegro, Podgorica, Montenegro
| | | | - Saša Raičević
- Clinic of Gynecology and Obstetrics, Clinical Center of Montenegro, Podgorica, Montenegro.,Medical faculty, University of Montenegro, Podgorica, Montenegro
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Mak ASL, Tang THC, Lam KW, Kwok ALM, Cheuk W, Wu TC, Leung KY. Prenatal sonography of placental abscess and prolonged antibiotic treatment for Serratia marcescens bacteremia. Clin Case Rep 2018. [PMID: 29531736 PMCID: PMC5838271 DOI: 10.1002/ccr3.1406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Termination of pregnancy is indicated for Serratia marcescens bacteremia, a major cause of mortality. Our present case was highly challenging because the patient wished to continue with her pregnancy, and the ultrasonography showed features of a placental abscess. Although the outcomes were good after prolonged antibiotic treatment, this was an exceptional case.
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Affiliation(s)
- Annisa Shui Lam Mak
- Department of Obstetrics and Gynecology Queen Elizabeth Hospital Hong Kong SAR China
| | - Tommy Hing Cheung Tang
- Division of Infectious Diseases Department of medicine Queen Elizabeth Hospital Hong Kong SAR China
| | - Kwok Wai Lam
- Division of Infectious Diseases Department of medicine Queen Elizabeth Hospital Hong Kong SAR China
| | | | - Wah Cheuk
- Department of Pathology Queen Elizabeth Hospital Hong Kong SAR China
| | - Tak Chiu Wu
- Division of Infectious Diseases Department of medicine Queen Elizabeth Hospital Hong Kong SAR China
| | - Kwok Yin Leung
- Department of Obstetrics and Gynecology Queen Elizabeth Hospital Hong Kong SAR China
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