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Jain A, Jain K, Jhurani D, Mishra A, Mohapatra S, Sharma A, Manchanda V, Sankar MJ, Agarwal R. Umbilical Cord Blood IgA Levels and Bacterial Profile in Preterm Neonates Born with Maternal Risk Factors for Early-Onset Neonatal Sepsis. Indian J Pediatr 2024; 91:541-547. [PMID: 37523074 DOI: 10.1007/s12098-023-04708-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To investigate the IgA levels and bacterial profile in umbilical cord blood (UCB) samples of mothers with risk factors compared to those without risk factors; and to understand the link between UCB culture positivity and neonatal outcomes [early-onset sepsis (EOS) or death within 7 d of life]. METHODS This is a pilot prospective case-control study. Mothers with preterm deliveries (gestational age <34 wk) were enrolled in two groups- Cases: Those with antenatal risk factors (prolonged duration of rupture of membranes of ≥24 h or chorioamnionitis) and controls: Those without these two risk factors. Serum IgA levels was assayed and microbiological culture was tested in UCB samples. 16S sequencing to determine the UCB microbiome was performed in a subset of samples (n = 15). Neonates were followed-up for the occurrence of EOS or death until 7 d of life. RESULTS Forty-nine mothers as cases and 50 mothers as controls were consecutively enrolled. No significant difference was observed in the IgA levels (60.5 vs. 58.1 mg/L; p = 0.71), neonatal blood culture positivity (4.1% vs. 8.0%; p = 0.41) and UCB culture positivity (30.6% vs. 26.0%; p = 0.61) in the two groups. No difference was observed between the groups in occurrence of EOS or death within 7 d of life. Proteobacteria, Firmicutes and Actinobacteria were the most abundant phyla. Serratia, Bifidobacterium, Collinsella, Meganomas and Blautia being the most common genera. CONCLUSIONS Cord blood IgA concentration could not differentiate the neonates at-risk of infection due to its presence in both the groups.
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Affiliation(s)
- Ashish Jain
- Department of Neonatology, Central Health Service, Maulana Azad Medical College, (University of Delhi), Govt. of India, New Delhi, India
| | - Kajal Jain
- Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Health, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Divashree Jhurani
- Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Health, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Asha Mishra
- Department of Gastroenterology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sarita Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Akash Sharma
- Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Health, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vikas Manchanda
- Department of Microbiology, Central Health Service, Maulana Azad Medical College, (University of Delhi), Govt. of India, New Delhi, India
| | - M Jeeva Sankar
- Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Health, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ramesh Agarwal
- Department of Pediatrics, WHO Collaborating Centre for Education and Research in Newborn Health, Newborn Health Knowledge Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
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Arora S, Myat Oo A, Shaik Ismail B, Poon WB, Lai D, Ko KKK, Wong HM, Tan KY, Aung MK, Conceicao E, Yang Y, Chan DYW, Sim JXY, Venkatachalam I, Lee LC, Ling ML. Rapid management of Serratia marcescens outbreak in neonatology unit in Singapore: Risk factors and infection control measures. Am J Infect Control 2024:S0196-6553(24)00500-5. [PMID: 38761850 DOI: 10.1016/j.ajic.2024.05.006] [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: 02/01/2024] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND We describe the investigations for control of two consecutive Serratia marcescens outbreaks in neonatology unit of Singapore General Hospital. METHODS Epidemiological investigations, environmental sampling and risk-factors analysis were performed to guide infection control measures. Active surveillance sampling of nasopharyngeal aspirate and/or stool from neonates was conducted during both outbreaks. Whole-genome-sequencing was done to determine clonal links. Retrospective case-control study was conducted for second outbreak to identify risk factors for S marcescens acquisition. RESULTS In 2022, two genetically unrelated S marcescens outbreaks were managed involving five neonates in March 2022 (outbreak 1) and eight neonates in November 2022 (outbreak 2). A link to positive isolates from sinks in intensive care units and milk preparation room was identified during outbreak 1. Neonatal jaundice (aOR, 16.46; p-value= 0.023) and non-formula milk feeding (aOR, 13.88; p-value= 0.02) were identified as risk factors during second outbreak. Multiple interventions adopted were cohorting of positive cases, carriage-screening, enhanced environmental cleaning, and emphasis on alcohol-based handrubs for hand-hygiene. CONCLUSION The two outbreaks were likely due to infection prevention practices lapses and favourable environmental conditions. Nosocomial S marcescens outbreaks in neonatology units are difficult to control and require multidisciplinary approach with strict infection prevention measures to mitigate risk factors.
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Affiliation(s)
- Shalvi Arora
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.
| | - Aung Myat Oo
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Bushra Shaik Ismail
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Woei Bing Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore
| | - Deborah Lai
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore; Department of Molecular Pathology, Singapore General Hospital, Singapore, Singapore
| | - Karrie Kwan Ki Ko
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Hei Man Wong
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Kwee Yuen Tan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Edwin Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Yong Yang
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Darius Yak Weng Chan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Jean Xiang Ying Sim
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Indumathi Venkatachalam
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Lai Chee Lee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
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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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Bourdin T, Benoit MÈ, Bédard E, Prévost M, Quach C, Déziel E, Constant P. High-Throughput Short Sequence Typing Schemes for Pseudomonas aeruginosa and Stenotrophomonas maltophilia Pure Culture and Environmental DNA. Microorganisms 2023; 12:48. [PMID: 38257875 PMCID: PMC10819370 DOI: 10.3390/microorganisms12010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Molecular typing techniques are utilized to determine genetic similarities between bacterial isolates. However, the use of environmental DNA profiling to assess epidemiologic links between patients and their environment has not been fully explored. This work reports the development and validation of two high-throughput short sequence typing (HiSST) schemes targeting the opportunistic pathogens Pseudomonas aeruginosa and Stenotrophomonas maltophilia, along with a modified SM2I selective medium for the specific isolation of S. maltophilia. These HiSST schemes are based on four discriminative loci for each species and demonstrate high discriminating power, comparable to pairwise whole-genome comparisons. Each scheme includes species-specific PCR primers for precise differentiation from closely related taxa, without the need for upstream culture-dependent methods. For example, the primers targeting the bvgS locus make it possible to distinguish P. aeruginosa from the very closely related Pseudomonas paraeruginosa sp. nov. The selected loci included in the schemes are adapted to massive parallel amplicon sequencing technology. An R-based script implemented in the DADA2 pipeline was assembled to facilitate HiSST analyses for efficient and accurate genotyping of P. aeruginosa and S. maltophilia. We demonstrate the performance of both schemes through in silico validations, assessments against reference culture collections, and a case study involving environmental samples.
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Affiliation(s)
- Thibault Bourdin
- Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, 531 Boulevard des Prairies, Laval, QC H7V 1B7, Canada;
| | - Marie-Ève Benoit
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (M.-È.B.); (C.Q.)
| | - Emilie Bédard
- Department of Civil Engineering, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada; (E.B.); (M.P.)
| | - Michèle Prévost
- Department of Civil Engineering, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada; (E.B.); (M.P.)
| | - Caroline Quach
- CHU Sainte-Justine Research Center, Montréal, QC H3T 1C5, Canada; (M.-È.B.); (C.Q.)
| | - Eric Déziel
- Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, 531 Boulevard des Prairies, Laval, QC H7V 1B7, Canada;
| | - Philippe Constant
- Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, 531 Boulevard des Prairies, Laval, QC H7V 1B7, Canada;
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Bourdin T, Benoit MÈ, Monnier A, Bédard E, Prévost M, Charron D, Audy N, Gravel S, Sicard M, Quach C, Déziel E, Constant P. Serratia marcescens Colonization in a Neonatal Intensive Care Unit Has Multiple Sources, with Sink Drains as a Major Reservoir. Appl Environ Microbiol 2023; 89:e0010523. [PMID: 37067412 PMCID: PMC10231179 DOI: 10.1128/aem.00105-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023] Open
Abstract
Compelling evidence suggests a contribution of the sink environment to the transmission of opportunistic pathogens from the hospital environment to patients in neonatal intensive care units (NICU). In this study, the distribution of the opportunistic pathogen Serratia marcescens in the sink environment and newborns in a NICU was investigated. More than 500 sink drain and faucet samples were collected over the course of five sampling campaigns undertaken over 3 years. Distribution and diversity of S. marcescens were examined with a modified MacConkey medium and a high-throughput short-sequence typing (HiSST) method. Sink drains were an important reservoir of S. marcescens, with an average of 44% positive samples, whereas no faucet sample was positive. The genotypic diversity of S. marcescens was moderate, with an average of two genotypes per drain, while the spatial distribution of S. marcescens was heterogeneous. The genotypic profiles of 52 clinical isolates were highly heterogeneous, with 27 unique genotypes, of which 71% of isolates were found in more than one patient. S. marcescens acquisition during the first outbreaks was mainly caused by horizontal transmissions. HiSST analyses revealed 10 potential cases of patient-to-patient transmission of S. marcescens, five cases of patient-to-sink transmission, and one bidirectional transfer between sink and patient. Environmental and clinical isolates were found in sink drains up to 1 year after the first detection, supporting persisting drain colonization. This extensive survey suggests multiple reservoirs of S. marcescens within the NICU, including patients and sink drains, but other external sources should also be considered. IMPORTANCE The bacterium Serratia marcescens is an important opportunistic human pathogen that thrives in many environments, can become multidrug resistant, and is often involved in nosocomial outbreaks in neonatal intensive care units (NICU). We evaluated the role of sinks during five suspected S. marcescens outbreaks in a NICU. An innovative approach combining molecular and culture methods was used to maximize the detection and typing of S. marcescens in the sink environment. Our results indicate multiple reservoirs of S. marcescens within the NICU, including patients, sink drains, and external sources. These results highlight the importance of sinks as a major reservoir of S. marcescens and potential sources of future outbreaks.
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Affiliation(s)
- Thibault Bourdin
- INRS–Centre Armand-Frappier Santé Biotechnologie, Laval, Quebec, Canada
| | | | - Alizée Monnier
- INRS–Centre Armand-Frappier Santé Biotechnologie, Laval, Quebec, Canada
| | | | | | | | - Nathalie Audy
- CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Sophie Gravel
- CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Mélanie Sicard
- CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Caroline Quach
- CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Eric Déziel
- INRS–Centre Armand-Frappier Santé Biotechnologie, Laval, Quebec, Canada
| | - Philippe Constant
- INRS–Centre Armand-Frappier Santé Biotechnologie, Laval, Quebec, Canada
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Coggins SA, Edwards EM, Flannery DD, Gerber JS, Horbar JD, Puopolo KM. Serratia Infection Epidemiology Among Very Preterm Infants in the Neonatal Intensive Care Unit. Pediatr Infect Dis J 2023; 42:152-158. [PMID: 36638403 PMCID: PMC9846441 DOI: 10.1097/inf.0000000000003736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Serratia spp. are opportunistic, multidrug resistant, Gram-negative pathogens, previously described among preterm infants in case reports or outbreaks of infection. We describe Serratia late-onset infection (LOI) in very preterm infants in a large, contemporary, nationally representative cohort. METHODS In this secondary analysis of prospectively collected data of preterm infants born 401-1500 grams and/or 22-29 weeks gestational age from 2018 to 2020 at 774 Vermont Oxford Network members, LOI was defined as culture-confirmed blood and/or cerebrospinal fluid infection > 3 days after birth. The primary outcome was incidence of Serratia LOI. Secondary outcomes compared rates of survival and discharge morbidities between infants with Serratia and non-Serratia LOI. RESULTS Among 119,565 infants, LOI occurred in 10,687 (8.9%). Serratia was isolated in 279 cases (2.6% of all LOI; 2.3 Serratia infections per 1000 infants). Of 774 hospitals, 161 (21%) reported at least one Serratia LOI; 170 of 271 (63%) cases occurred at hospitals reporting 1 or 2 Serratia infections, and 53 of 271 (20%) occurred at hospitals reporting ≥5 Serratia infections. Serratia LOI was associated with a lower rate of survival to discharge compared with those with non-Serratia LOI (adjusted relative risk 0.88, 95% CI: 0.82-0.95). Among survivors, infants with Serratia LOI had higher rates of tracheostomy, gastrostomy and home oxygen use compared with those with non-Serratia LOI. CONCLUSIONS The incidence of Serratia LOI was 2.3 infections per 1000 very preterm infants in this cohort. Lower survival and significant morbidity among Serratia LOI survivors highlight the need for recognition and targeted prevention strategies for this opportunistic nosocomial infection.
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Affiliation(s)
- Sarah A. Coggins
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Erika M. Edwards
- University of Vermont, Burlington, VT, USA
- Vermont-Oxford Network, Burlington, VT, USA
| | - Dustin D. Flannery
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jeffrey S. Gerber
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jeffrey D. Horbar
- University of Vermont, Burlington, VT, USA
- Vermont-Oxford Network, Burlington, VT, USA
| | - Karen M. Puopolo
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Howard-Jones AR, Janto C, Jennings Z, Branley J, Wang Q, Sintchenko V, Samarasekara H. Prompt control of a Serratia marcescens outbreak in a neonatal intensive care unit informed by whole-genome sequencing and comprehensive infection control intervention package. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e104. [PMID: 36483351 PMCID: PMC9726519 DOI: 10.1017/ash.2022.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This report describes a cluster of patients infected by Serratia marcescens in a metropolitan neonatal intensive care unit (NICU) and a package of infection control interventions that enabled rapid, effective termination of the outbreak. DESIGN Cross-sectional analytical study using whole-genome sequencing (WGS) for phylogenetic cluster analysis and identification of virulence and resistance genes. SETTING NICU in a metropolitan tertiary-care hospital in Sydney, Australia. PATIENTS All neonates admitted to the level 2 and level 3 neonatal unit. INTERVENTIONS Active inpatient and environmental screening for Serratia marcescens isolates with WGS analysis for identification of resistance genes as well as cluster relatedness between isolates. Planning and implementation of a targeted, multifaceted infection control intervention. RESULTS The cluster of 10 neonates colonized or infected with Serratia marcescens was identified in a metropolitan NICU. Two initial cases involved devastating intracranial infections with brain abscesses, highlighting the virulence of this organism. A targeted and comprehensive infection control intervention guided by WGS findings enabled termination of this outbreak within 15 days of onset. WGS examination demonstrated phylogenetic linkage across the cluster, and genomic unrelatedness of later strains identified in the neonatal unit and elsewhere. CONCLUSIONS A comprehensive, multipronged, infection control package incorporating close stakeholder engagement, frequent microbiological patient screening, environmental screening, enhanced cleaning, optimization of hand hygiene and healthcare worker education was paramount to the prompt control of Serratia marcescens transmission in this neonatal outbreak. WGS was instrumental in establishing relatedness between isolates and identification of possible transmission pathways in an outbreak setting.
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Affiliation(s)
- Annaleise R. Howard-Jones
- New South Wales Health Pathology-Nepean, Penrith, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine Janto
- New South Wales Health Pathology-Nepean, Penrith, New South Wales, Australia
| | - Zoe Jennings
- Department of Microbiology and Infectious Diseases, Nepean Hospital, Kingswood, New South Wales, Australia
| | - James Branley
- New South Wales Health Pathology-Nepean, Penrith, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Department of Microbiology and Infectious Diseases, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Qinning Wang
- Centre for Infectious Diseases & Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology & Medical Research, Westmead, New South Wales, Australia
| | - Vitali Sintchenko
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Centre for Infectious Diseases & Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology & Medical Research, Westmead, New South Wales, Australia
| | - Harsha Samarasekara
- New South Wales Health Pathology-Nepean, Penrith, New South Wales, Australia
- Department of Microbiology and Infectious Diseases, Nepean Hospital, Kingswood, New South Wales, Australia
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8
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Hou J, Mao D, Zhang Y, Huang R, Li L, Wang X, Luo Y. Long-term spatiotemporal variation of antimicrobial resistance genes within the Serratia marcescens population and transmission of S. marcescens revealed by public whole-genome datasets. JOURNAL OF HAZARDOUS MATERIALS 2022; 423:127220. [PMID: 34844350 DOI: 10.1016/j.jhazmat.2021.127220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/05/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
The development of antimicrobial resistance (AMR) is accelerated by the selective pressure exerted by the widespread use of antimicrobial drugs, posing an increasing danger to public health. However, long-term spatiotemporal variation in AMR genes in microorganisms, particularly in bacterial pathogens in response to antibiotic consumption, is not fully understood. Here, we used the NCBI RefSeq database to collect 478 whole-genome sequences for Serratia marcescens ranging from 1961 up to 2019, to document global long-term AMR trends in S. marcescens populations. In total, 100 AMR gene subtypes (16 AMR gene types) were detected in the genomes of S. marcescens populations. We identified 3 core resistance genes in S. marcescens genomes, and a high diversity of AMR genes was observed in S. marcescens genomes after corresponding antibiotics were discovered and introduced into clinical practice, suggesting the adaptation of S. marcescens populations to challenges with therapeutic antibiotics. Our findings indicate spatiotemporal variation of AMR genes in S. marcescens populations in relation to antibiotic consumption and suggest the potential transmission of S. marcescens isolates harboring AMR genes among countries and between the environment and the clinic, representing a public health threat that necessitates international solidarity to overcome.
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Affiliation(s)
- Jie Hou
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Daqing Mao
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Yulin Zhang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Ruiyang Huang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Linyun Li
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Xiaolong Wang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Yi Luo
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China; State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210093, China.
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9
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A High-Throughput Short Sequence Typing Scheme for Serratia marcescens Pure Culture and Environmental DNA. Appl Environ Microbiol 2021; 87:e0139921. [PMID: 34586910 DOI: 10.1128/aem.01399-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Molecular typing methods are used to characterize the relatedness between bacterial isolates involved in infections. These approaches rely mostly on discrete loci or whole-genome sequencing (WGS) analyses of pure cultures. On the other hand, their application to environmental DNA profiling to evaluate epidemiological relatedness among patients and environments has received less attention. We developed a specific, high-throughput short sequence typing (HiSST) method for the opportunistic human pathogen Serratia marcescens. Genes displaying the highest polymorphism were retrieved from the core genome of 60 S. marcescens strains. Bioinformatics analyses showed that use of only three loci (within bssA, gabR, and dhaM) distinguished strains with a high level of efficiency. This HiSST scheme was applied to an epidemiological survey of S. marcescens in a neonatal intensive care unit (NICU). In a first case study, a strain responsible for an outbreak in the NICU was found in a sink drain of this unit, by using HiSST scheme and confirmed by WGS. The HiSST scheme was also applied to environmental DNA extracted from sink-environment samples. Diversity of S. marcescens was modest, with 11, 6, and 4 different sequence types (ST) of gabR, bssA, and dhaM loci among 19 sink drains, respectively. Epidemiological relationships among sinks were inferred on the basis of pairwise comparisons of ST profiles. Further research aimed at relating ST distribution patterns to environmental features encompassing sink location, utilization, and microbial diversity is needed to improve the surveillance and management of opportunistic pathogens. IMPORTANCE Serratia marcescens is an important opportunistic human pathogen, often multidrug resistant and involved in outbreaks of nosocomial infections in neonatal intensive care units. Here, we propose a quick and user-friendly method to select the best typing scheme for nosocomial outbreaks in relating environmental and clinical sources. This method, named high-throughput short sequence typing (HiSST), allows to distinguish strains and to explore the diversity profile of nonculturable S. marcescens. The application of HiSST profile analysis for environmental DNA offers new possibilities to track opportunistic pathogens, identify their origin, and relate their distribution pattern with environmental features encompassing sink location, utilization, and microbial diversity. Adaptation of the method to other opportunistic pathogens is expected to improve knowledge regarding their ecology, which is of significant interest for epidemiological risk assessment and elaborate outbreak mitigation strategies.
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Böhne C, Chhatwal P, Peter C, Ebadi E, Hansen G, Schlüter D, Bange FC, Bohnhorst B, Baier C. Detection of Serratia marcescens in neonatal intensive care units requires a rapid and comprehensive infection control response starting with the very first case. GMS HYGIENE AND INFECTION CONTROL 2021; 16:Doc12. [PMID: 33796440 PMCID: PMC7983028 DOI: 10.3205/dgkh000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Serratia marcescens is a well-known and challenging pathogen in neonatal intensive care units. It is responsible for severe infections and can cause nosocomial outbreaks. Methods: We present the infection control response to a Serratia marcescens cluster which occurred in a tertiary neonatal intensive care unit. Results and conclusions: The presented comprehensive and decisive hygiene management response starting with the very first case aims especially at early detection and immediate interruption of nosocomial transmission. Frequent and sensitive microbiological screening, rigorous spatial isolation of colonized infants, and reinforcing adherence to hand hygiene are essential in this response, which comprises eight measures. It prevented a full-blown outbreak.
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Affiliation(s)
- Carolin Böhne
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Patrick Chhatwal
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Corinna Peter
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Ella Ebadi
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Dirk Schlüter
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Franz-Christoph Bange
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Bettina Bohnhorst
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Claas Baier
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany,*To whom correspondence should be addressed: Claas Baier, Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany, Phone: +49 511 532 8675, Fax: +49 511 532 8174, E-mail:
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Whole-genome sequencing for neonatal intensive care unit outbreak investigations: Insights and lessons learned. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2021; 1:e2. [PMID: 36168459 PMCID: PMC9495531 DOI: 10.1017/ash.2021.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/20/2022]
Abstract
Abstract
Infectious diseases outbreaks are a cause of significant morbidity and mortality among hospitalized patients. Infants admitted to the neonatal intensive care unit (NICU) are particularly vulnerable to infectious complications during hospitalization. Thus, rapid recognition of and response to outbreaks in the NICU is essential. At Rush University Medical Center, whole-genome sequencing (WGS) has been utilized since early 2016 as an adjunctive method for outbreak investigations. The use of WGS and potential lessons learned are illustrated for 3 different NICU outbreak investigations involving methicillin-resistant Staphylococcus aureus (MRSA), group B Streptococcus (GBS), and Serratia marcescens. WGS has contributed to the understanding of the epidemiology of outbreaks in our NICU, and it has also provided further insight in settings of unusual diseases or when lower-resolution typing methods have been inadequate. WGS has emerged as the new gold standard for evaluating strain relatedness. As barriers to implementation are overcome, WGS has the potential to transform outbreak investigation in healthcare settings.
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Is there a widespread clone of Serratia marcescens producing outbreaks worldwide? J Hosp Infect 2020; 108:7-14. [PMID: 33181279 DOI: 10.1016/j.jhin.2020.10.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Serratia marcescens frequently causes outbreaks in healthcare settings. There are few studies using high-throughput sequencing (HTS) that analyse S. marcescens outbreaks. We present the analysis of two outbreaks in neonatal intensive care units (NICUs) in hospitals from the Comunitat Valenciana (CV, Spain) and the impact of using different reference genomes. METHODS DNA from cultured isolates was extracted and sequenced by HTS using Illumina NextSeq. Reads were mapped against two reference genomes, strains UMH9 and Db11, and the unmapped fraction of the genomes was assembled to fully genetically characterize the isolates. FINDINGS Isolates from the first outbreak were identical to the UMH9 reference, an unrelated isolate obtained three years earlier in the USA. This did not occur when the Db11 strain, a standard reference for S. marcescens, was used as the reference for mapping. To check whether UMH9 was a widely distributed clone spreading in the CV, the second outbreak isolates were mapped against this reference. They were not closely related to this strain, and this outbreak could be defined as such regardless of the reference used for mapping the reads. CONCLUSIONS The choice of the reference for genomic analysis of outbreaks is a critical decision. In the case of the first outbreak, this choice changed the interpretation of the results drastically, allowing or preventing the definition of the outbreak according to the reference used. Although HTS is a powerful tool for epidemiological analysis, it is still essential to collect microbiological and epidemiological data for the correct interpretation of the results.
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Ferreira RL, Rezende GS, Damas MSF, Oliveira-Silva M, Pitondo-Silva A, Brito MCA, Leonardecz E, de Góes FR, Campanini EB, Malavazi I, da Cunha AF, Pranchevicius MCDS. Characterization of KPC-Producing Serratia marcescens in an Intensive Care Unit of a Brazilian Tertiary Hospital. Front Microbiol 2020; 11:956. [PMID: 32670210 PMCID: PMC7326048 DOI: 10.3389/fmicb.2020.00956] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
Serratia marcescens has emerged as an important opportunistic pathogen responsible for nosocomial and severe infections. Here, we determined phenotypic and molecular characteristics of 54 S. marcescens isolates obtained from patient samples from intensive-care-unit (ICU) and neonatal intensive-care-unit (NIUC) of a Brazilian tertiary hospital. All isolates were resistant to beta-lactam group antibiotics, and 92.6% (50/54) were not susceptible to tigecycline. Furthermore, 96.3% showed intrinsic resistance to polymyxin E (colistin), a last-resort antibiotic for the treatment of infections caused by MDR (multidrug-resistant) Gram-negative bacteria. In contrast, high susceptibility to other antibiotics such as fluoroquinolones (81.5%), and to aminoglycosides (as gentamicin 81.5%, and amikacin 85.2%) was found. Of all isolates, 24.1% were classified as MDR. The presence of resistance and virulence genes were examined by PCR and sequencing. All isolates carried KPC-carbapenemase (blaKPC) and extended spectrum beta-lactamase blaTEM genes, 14.8% carried blaOXA–1, and 16.7% carried blaCTX–M–1group genes, suggesting that bacterial resistance to β-lactam antibiotics found may be associated with these genes. The genes SdeB/HasF and SdeY/HasF that are associated with efflux pump mediated drug extrusion to fluoroquinolones and tigecycline, respectively, were found in 88.9%. The aac(6′)-Ib-cr variant gene that can simultaneously induce resistance to aminoglycoside and fluoroquinolone was present in 24.1% of the isolates. Notably, the virulence genes to (i) pore-forming toxin (ShlA); (ii) phospholipase with hemolytic and cytolytic activities (PhlA); (iii) flagellar transcriptional regulator (FlhD); and (iv) positive regulator of prodigiosin and serratamolide production (PigP) were present in 98.2%. The genetic relationship among the isolates determined by ERIC-PCR demonstrated that the vast majority of isolates were grouped in a single cluster with 86.4% genetic similarity. In addition, many isolates showed 100% genetic similarity to each other, suggesting that the S. marcescens that circulate in this ICU are closely related. Our results suggest that the antimicrobial resistance to many drugs currently used to treat ICU and NIUC patients, associated with the high frequency of resistance and virulence genes is a worrisome phenomenon. Our findings emphasize the importance of active surveillance plans for infection control and to prevent dissemination of these strains.
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Affiliation(s)
- Roumayne L Ferreira
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Graziela S Rezende
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | - Mariana Oliveira-Silva
- Programas de Pós-graduação em Odontologia e Tecnologia Ambiental, Universidade de Ribeirão Preto, Ribeirão Preto, Brazil
| | - André Pitondo-Silva
- Programas de Pós-graduação em Odontologia e Tecnologia Ambiental, Universidade de Ribeirão Preto, Ribeirão Preto, Brazil
| | - Márcia C A Brito
- Laboratório Central de Saúde Pública do Tocantins, Palmas, Brazil
| | - Eduardo Leonardecz
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Fabiana R de Góes
- Instituto de Ciências Matemáticas e de Computação, Universidade de São Paulo, São Carlos, Brazil
| | - Emeline Boni Campanini
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Iran Malavazi
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Anderson F da Cunha
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
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Keck N, Dunie-Merigot A, Dazas M, Hirchaud E, Laurence S, Gervais B, Madec JY, Haenni M. Long-lasting nosocomial persistence of chlorhexidine-resistant Serratia marcescens in a veterinary hospital. Vet Microbiol 2020; 245:108686. [PMID: 32456825 DOI: 10.1016/j.vetmic.2020.108686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022]
Abstract
Healthcare-associated infections (HAIs) are often overlooked in veterinary medicine. Serratia marcescens isolates were recovered over a ten-year period from companion animals in a French veterinary hospital. The pets were sampled either for diagnostic purposes or to monitor colonization. A retrospective study showed that 32 S. marcescens isolates were identified as HAI cases and a further 22 cases were associated with colonization of the surgical site. Two S. marcescens lineages were responsible for two different outbreaks during the study period. Chlorhexidine solution (1%) used to impregnate gauze was found to be the source of the second S. marcescens outbreak and all isolates had high MIC values for chlorhexidine (MIC = 128 mg/L). This study reports, for the first time to our knowledge, the nosocomial spread of chlorhexidine-resistant S. marcescens in a veterinary setting and highlights consequences of the improper use of disinfectants.
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Affiliation(s)
- Nicolas Keck
- Laboratoire Départemental Vétérinaire de l'Hérault, 306 rue Croix de Las Cazes, 34967 Montpellier, Cedex 2, France.
| | - Antoine Dunie-Merigot
- Centre Hospitalier Vétérinaire Languedocia, 395 Rue Maurice Béjart, 34080 Montpellier, France
| | - Mélody Dazas
- Unité Antibiorésistance et Virulence Bactériennes, Université de Lyon - ANSES, 31 avenue Tony Garnier, 69007 Lyon cedex, France
| | - Edouard Hirchaud
- Viral Genetic and Biosecurity Unit, BP53, ANSES Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France
| | - Stéphanie Laurence
- Laboratoire Départemental Vétérinaire de l'Hérault, 306 rue Croix de Las Cazes, 34967 Montpellier, Cedex 2, France
| | - Béatrice Gervais
- Laboratoire Départemental Vétérinaire de l'Hérault, 306 rue Croix de Las Cazes, 34967 Montpellier, Cedex 2, France
| | - Jean-Yves Madec
- Unité Antibiorésistance et Virulence Bactériennes, Université de Lyon - ANSES, 31 avenue Tony Garnier, 69007 Lyon cedex, France
| | - Marisa Haenni
- Unité Antibiorésistance et Virulence Bactériennes, Université de Lyon - ANSES, 31 avenue Tony Garnier, 69007 Lyon cedex, France.
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Serratia marcescens in the neonatal intensive care unit: A cluster investigation using molecular methods. J Infect Public Health 2019; 13:1006-1011. [PMID: 31883745 DOI: 10.1016/j.jiph.2019.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/21/2019] [Accepted: 12/05/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Serratia marcescens (S. marcescens) is associated with nosocomial infections with significant morbidity and mortality in the neonatal intensive care units (NICU). We describe the control of a multi-clonal S. marcescens infections outbreak in our tertiary-level NICU and the application of molecular typing using repetitive element palindromic PCR (rep-PCR) and next generation sequencing (NGS) in the investigation. METHODS Outbreak investigation was performed where clinical, spatial and epidemiologic links were established. Screening of all infants in the NICU and the environment was performed. Rep-PCR and NGS methods were used to identify potential environmental sources of infections and clustering among cases. RESULTS Eleven cases were detected during the outbreak period: mean gestational age 27 weeks (range: 24-32), predominantly male (82%), mean age of infection 24 days (range: 6-51). Six infants were treated for conjunctivitis and one for bacteraemia. Identification of colonized infant via a point prevalence survey and cohorting of all infected/colonized patients were implemented. We performed environmental swabbing of surfaces, water outlets, chlorhexidine hand wash solutions and hand hygiene hand rubs. Both rep-PCR and NGS classified the 11 case isolates into 5 types. No point source was identified except for a single positive environmental isolate from a sink which was clonally distinct from the cases. CONCLUSION Identification and cohorting of infected/colonized patient was important in the control of S. marcescens outbreak in the NICU. The utility of rep-PCR was comparable to NGS in providing molecular information to develop S. marcescens outbreak control strategies.
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Serratia microhaemolytica sp. nov., isolated from an artificial lake in Southern China. Antonie van Leeuwenhoek 2019; 112:1447-1456. [DOI: 10.1007/s10482-019-01273-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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Rohit A, Suresh Kumar D, Dhinakaran I, Joy J, Vijay Kumar D, Kumar Ballamoole K, Karunasagar I, Karola P, Dag H. Whole-genome-based analysis reveals multiclone Serratia marcescens outbreaks in a non-Neonatal Intensive Care Unit setting in a tertiary care hospital in India. J Med Microbiol 2019; 68:616-621. [PMID: 30839251 DOI: 10.1099/jmm.0.000947] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We report the use of next generation sequencing (NGS) for investigating an outbreak of 13 cases of Serratia marcescens blood stream infections in a non-Neonatal Intensive Care Unit (non-NICU) setting in a tertiary care hospital in India over 5 months. Thirteen cases of sepsis due to S. marcescens were identified in various Intensive Care Units (ICUs) over 5 months. Environmental surveillance identified isolates in the adult ICU (AICU). Antibiogram did not correlate with timeline. Sequencing libraries were prepared using Nextera XT chemistry (Illumina). Based on NGS, two clusters were identified. Cluster 1 had environmental and clinical isolates from the AICU and cluster 2 were isolates from the Coronary Care Unit (CCU). NICU and Paediatric ICU isolates did not belong to any cluster. Polyclonal outbreaks best identified by NGS can occur simultaneously. Good infection prevention practices like hand hygiene for compounded medicines and surface cleaning helped end the outbreak.
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Affiliation(s)
- Anusha Rohit
- Department of Microbiology and Infection Control, The Madras Medical Mission, Mogappair, Chennai 600037, India
| | - D Suresh Kumar
- Department of Microbiology and Infection Control, The Madras Medical Mission, Mogappair, Chennai 600037, India
| | - I Dhinakaran
- Department of Microbiology and Infection Control, The Madras Medical Mission, Mogappair, Chennai 600037, India
| | - Jessy Joy
- Department of Microbiology and Infection Control, The Madras Medical Mission, Mogappair, Chennai 600037, India
| | - Deekshit Vijay Kumar
- Division of Infectious Disease, Centre for Science Education and Research, Nitte (Deemed to be University), Deralakatte, Mangaluru 575018, India
| | - Krishna Kumar Ballamoole
- Division of Infectious Disease, Centre for Science Education and Research, Nitte (Deemed to be University), Deralakatte, Mangaluru 575018, India
| | - I Karunasagar
- Division of Infectious Disease, Centre for Science Education and Research, Nitte (Deemed to be University), Deralakatte, Mangaluru 575018, India
| | - Prior Karola
- Department of Periodontology and Restorative Dentistry, Muenster University Hospital, Waldeyerstrasse 30, 48149 Muenster, Germany
| | - Harmsen Dag
- Department of Periodontology and Restorative Dentistry, Muenster University Hospital, Waldeyerstrasse 30, 48149 Muenster, Germany
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Redondo-Bravo L, Gutiérrez-González E, San Juan-Sanz I, Fernández-Jiménez I, Ruiz-Carrascoso G, Gallego-Lombardo S, Sánchez-García L, Elorza-Fernández D, Pellicer-Martínez A, Omeñaca F, Robustillo-Rodela A. Serratia marcescens outbreak in a neonatology unit of a Spanish tertiary hospital: Risk factors and control measures. Am J Infect Control 2019; 47:271-279. [PMID: 30392995 DOI: 10.1016/j.ajic.2018.08.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND We describe the investigation undertaken and the measures adopted to control a Serratia marcescens outbreak in the neonatology unit of La Paz University Hospital in Madrid, Spain. METHODS Weekly rectal and pharyngeal screenings for S marcescens were performed in the neonates starting after detection of the outbreak. Environmental samples and samples from health care workers (HCWs) were obtained for microbiological analysis. An unmatched case-control study was carried out to investigate risk factors for infection/colonization. RESULTS The outbreak began in June 2016 and ended in March 2017, affecting a total of 59 neonates. Twenty-five (42.37%) neonates sustained an infection, most frequently conjunctivitis and sepsis. Multivariate logistic regression identified the following risk factors: parenteral nutrition (odds ratio [OR], 103.4; 95% confidence interval [CI], 11.9-894.8), history of previous radiography (OR, 15.3; 95% CI, 2.4-95.6), and prematurity (OR, 5.65; 95% CI, 1.5-21.8). Various measures were adopted to control the outbreak, such as strict contact precautions, daily multidisciplinary team meetings, cohorting, allocation of dedicated staff, unit disinfection, and partial closure. Hands of HCWs were the main suspected mechanism of transmission, based on the inconclusive results of the environmental investigation and the high number of HCWs and procedures performed in the unit. CONCLUSIONS S marcescens spreads easily in neonatology units, mainly in neonatal intensive care units, and is often difficult to control, requiring a multidisciplinary approach. Strict measures, including cohorting and medical attention by exclusive staff, are often needed to get these outbreaks under control.
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Affiliation(s)
- Lidia Redondo-Bravo
- Department of Preventive Medicine, La Paz University Hospital, Madrid, Spain.
| | | | | | | | | | | | | | | | | | - Félix Omeñaca
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
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Zingg W, Soulake I, Baud D, Huttner B, Pfister R, Renzi G, Pittet D, Schrenzel J, Francois P. Correction to: Management and investigation of a Serratia marcescens outbreak in a neonatal unit in Switzerland - the role of hand hygiene and whole genome sequencing. Antimicrob Resist Infect Control 2018; 7:6. [PMID: 29377022 PMCID: PMC5771065 DOI: 10.1186/s13756-017-0295-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 12/20/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s13756-017-0285-x.].
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Affiliation(s)
- Walter Zingg
- 1Infection Control Program and WHO Collaborating Center for Patient Safety, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, 14 Geneva, Switzerland
| | - Isabelle Soulake
- 1Infection Control Program and WHO Collaborating Center for Patient Safety, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, 14 Geneva, Switzerland
| | - Damien Baud
- 2Genomic Research Laboratory, Division of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland
| | - Benedikt Huttner
- 1Infection Control Program and WHO Collaborating Center for Patient Safety, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, 14 Geneva, Switzerland.,3Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Riccardo Pfister
- 4Neonatal Intensive Care Unit, Department of Paediatrics, University of Geneva Hospitals, Geneva, Switzerland
| | - Gesuele Renzi
- 5Bacteriology Laboratory, Department of Genetics and Laboratory Medicine, University of Geneva Hospitals, Geneva, Switzerland
| | - Didier Pittet
- 1Infection Control Program and WHO Collaborating Center for Patient Safety, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, 14 Geneva, Switzerland
| | - Jacques Schrenzel
- 2Genomic Research Laboratory, Division of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland.,5Bacteriology Laboratory, Department of Genetics and Laboratory Medicine, University of Geneva Hospitals, Geneva, Switzerland
| | - Patrice Francois
- 2Genomic Research Laboratory, Division of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland.,5Bacteriology Laboratory, Department of Genetics and Laboratory Medicine, University of Geneva Hospitals, Geneva, Switzerland
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An Outbreak of Serratia marcescens in a Moroccan Neonatal Intensive Care Unit. Adv Med 2018; 2018:4867134. [PMID: 30515424 PMCID: PMC6237015 DOI: 10.1155/2018/4867134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/30/2018] [Accepted: 09/13/2018] [Indexed: 11/18/2022] Open
Abstract
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.
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