Étude cas-témoins d’une épidémie à Serratia marcescens dans un service de réanimation pédiatrique

Infection control measures against multidrug-resistant Gram-negative bacteria in children and neonates

The increase in infections caused by multidrug-resistant (MDR) Gram-negative bacteria in neonatal and pediatric intensive care units over recent years is alarming. MDR Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii have constituted the main causes of the MDR Gram-negative bacteria problem. The implementation of infection control measures such as hand hygiene, cohorting of patients, contact precautions, active surveillance and environmental cleaning could diminish their spread. Recently, water safety has been identified as a major component of infection control policies. The aim of the current review is to highlight the effectiveness of these infection control measures in managing outbreaks caused by MDR Gram-negative bacteria in neonatal and pediatric intensive care units and highlight future perspectives on the topic.

An Outbreak of Serratia marcescens in a Moroccan Neonatal Intensive Care Unit

Serratia marcescens (S. marcescens) is an Enterobacteriaceae microorganism that is widespread in the environment, which may be the source of nosocomial infections, rare in the newborn but severe, and often in the form of outbreaks. The aim of our study is to report our experience, during an outbreak of S. marcescens, to show the severity of this germ, with review of the literature. Our study was retrospective, including 8 newborns with S. marcescens nosocomial infection, collected in the neonatal intensive care unit of Mohammed VI University Medical Hospital, during the epidemic period, over a period of 2 months (July and August 2016). The mean gestational age of the cases was 36 weeks of amenorrhea. Boys accounted for 75% of the cases. The average weight was 1853 grams. All the patients were initially placed under empiric antibiotic therapy based on ceftriaxone and gentamicin. The mean duration of nosocomial infection, diagnosed in all cases by blood cultures, was 7 days. The strains of S. marcescens were in 75% of the cases sensitive to the cephalosporins, intermediate sensitivity in 12.5% of cases and resistant in 12.5% of cases. The outcome was fatal in 62.5% of cases. S. marcescens nosocomial infections are often reported on epidemic series, and their eradication is not always easy.

Morphological and genetic analysis of three bacteriophages of Serratia marcescens isolated from environmental water

Increases in multidrug-resistant strains of Serratia marcescens are of great concern in pediatrics, especially in neonatal intensive care units. In the search for bacteriophages to control infectious diseases caused by multidrug-resistant S. marcescens, three phages (KSP20, KSP90, and KSP100) were isolated from environmental water and were characterized morphologically and genetically. KSP20 and KSP90 belonged to morphotype A1 of the family Myoviridae, and KSP100 belonged to morphotype C3 of the family Podoviridae. Analysis of the DNA region coding virion proteins, together with their morphological features, indicated that KSP20, KSP90, and KSP100 were related to the P2-like phage (temperate), T4-type phage (virulent), and phiEco32 phage (virulent), respectively. Based on amino acid sequences of the major capsid protein, KSP90 formed a new branch with a Stenotrophomonas maltophilia phage, Smp14, in the T4-type phage phylogeny. Both Smp14 and phiEco32 have been reported as potential therapeutic phages. These results suggest that KSP90 and KSP100 may be candidate therapeutic phages to control S. marcescens infection.