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Kamali A, Ferguson D, Dowless H, Ortiz N, Mukhopadhyay R, Schember C, Lunsford R, Hutchinson J, Scherer M, Crandall J, Bauer H, Yu A, Kimura A. Outbreak of Invasive Serratia marcescens among Persons Incarcerated in a State Prison, California, USA, March 2020-December 2022. Emerg Infect Dis 2024; 30:S41-S48. [PMID: 38561639 PMCID: PMC10986826 DOI: 10.3201/eid3013.230801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Serratia marcescens is an environmental gram-negative bacterium that causes invasive disease in rare cases. During 2020-2022, an outbreak of 21 invasive Serratia infections occurred in a prison in California, USA. Most (95%) patients had a history of recent injection drug use (IDU). We performed whole-genome sequencing and found isolates from 8 patients and 2 pieces of IDU equipment were closely related. We also identified social interactions among patients. We recovered S. marcescens from multiple environmental samples throughout the prison, including personal containers storing Cell Block 64 (CB64), a quaternary ammonium disinfectant solution. CB64 preparation and storage conditions were suboptimal for S. marcescens disinfection. The outbreak was likely caused by contaminated CB64 and propagated by shared IDU equipment and social connections. Ensuring appropriate preparation, storage, and availability of disinfectants and enacting interventions to counteract disease spread through IDU can reduce risks for invasive Serratia infections in California prisons.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rodríguez-Villodres Á, Ortiz de la Rosa JM, Valencia-Martin R, Jiménez Parrilla F, Martín-Gutiérrez G, Márquez Patiño N, Perea Cruz E, Sánchez Jiménez MT, Pavón Delgado A, Cisneros JM, Lepe JA. Implementation of a PCR-based strategy to control an outbreak by Serratia marcescens in a Neonatal Intensive Care Unit. Ann Clin Microbiol Antimicrob 2023; 22:108. [PMID: 38082303 PMCID: PMC10714559 DOI: 10.1186/s12941-023-00657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES To evaluate the clinical and epidemiological impact of a new molecular surveillance strategy based on qPCR to control an outbreak by Serratia marcescens in a Neonatal Intensive Care Unit (NICU). METHODS We design a specific qPCR for the detection of S. marcescens in rectal swabs of patients admitted to a NICU. We divided the surveillance study into two periods: (a) the pre-PCR, from the outbreak declaration to the qPCR introduction, and (b) the PCR period, from the introduction of the qPCR until the outbreak was solved. In all cases, S. marcescens isolates were recovered and their clonal relationship was analysed by PFGE. Control measures were implemented during the outbreak. Finally, the number of bloodstream infections (BSI) was investigated in order to evaluate the clinical impact of this molecular strategy. RESULTS Nineteen patients colonized/infected by S. marcescens were detected in the pre-PCR period (October 2020-April 2021). On the contrary, after the PCR implementation, 16 new patients were detected. The PFGE revealed 24 different pulsotypes belonging to 7 different clonal groups, that were not overlapping at the same time. Regarding the clinical impact, 18 months after the qPCR implementation, no more outbreaks by S. marcescens have been declared in the NICU of our hospital, and only 1 episode of BSI has occurred, compared with 11 BSI episodes declared previously to the outbreak control. CONCLUSIONS The implementation of this qPCR strategy has proved to be a useful tool to control the nosocomial spread of S. marcescens in the NICU.
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Affiliation(s)
- Ángel Rodríguez-Villodres
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Av. Manuel Siurot s/n, 41013, Seville, Spain.
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC). Instituto de Salud Carlos III, Madrid, Spain.
| | - José Manuel Ortiz de la Rosa
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Av. Manuel Siurot s/n, 41013, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain
| | - Raquel Valencia-Martin
- Clinical Unit of Preventive Medicine and Public Health, University Hospital Virgen del Rocío, Seville, Spain
- Department of Preventive Medicine, University of Seville, Seville, Spain
| | | | - Guillermo Martín-Gutiérrez
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Av. Manuel Siurot s/n, 41013, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC). Instituto de Salud Carlos III, Madrid, Spain
| | - Natividad Márquez Patiño
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Av. Manuel Siurot s/n, 41013, Seville, Spain
| | - Estela Perea Cruz
- Clinical Unit of Preventive Medicine and Public Health, University Hospital Virgen del Rocío, Seville, Spain
| | | | | | - José Miguel Cisneros
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Av. Manuel Siurot s/n, 41013, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC). Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Medicine, University of Seville, Seville, Spain
| | - José Antonio Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Av. Manuel Siurot s/n, 41013, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío, CSIC, University of Seville, Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC). Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, University of Seville, Seville, Spain
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Liu X, Yan Z, Ye L, Wang K, Li J, Lin Y, Liao C, Liu Y, Li P, Du M. Genomic epidemiological investigation of an outbreak of Serratia marcescens neurosurgical site infections associated with contaminated haircutting toolkits in a hospital barber shop. J Hosp Infect 2023; 142:58-66. [PMID: 37774927 DOI: 10.1016/j.jhin.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Nine surgical site infections caused by Serratia marcescens were diagnosed in neurosurgical patients in a 3500-bed hospital between 2nd February and 6th April 2022. OBJECTIVE To trace the source of infections caused by S. marcescens to expedite termination of the outbreak and prevent future epidemics. METHODS A review of all surgical procedures and cultures yielding S. marcescens since February 2022 was conducted. Samples were collected from patients and environmental sources. S. marcescens isolates were characterized by antibiotic susceptibility testing. Whole-genome sequencing (WGS) was used to investigate genetic relationships. Resistance genes, virulence genes and plasmid replicons were identified. RESULTS S. marcescens was isolated from patients' puncture fluid, cerebrospinal fluid and other secretions, and was also cultured from the barbers' haircutting tools, including leather knives, slicker scrapers and razors. In total, 15 isolates were obtained from patients and eight isolates were obtained from haircutting tools. All isolates exhibited identical antibiotic resistance patterns. WGS revealed close clustering among the 23 isolates which differed significantly from previous strains. Three resistance genes and nine virulence-associated genes were detected in all isolates, and 19 of 23 isolates harboured an MOBP-type plasmid. The results confirmed an outbreak of S. marcescens, which was traced to contaminated haircutting tools in the hospital barber shop. The outbreak ended after extensive reinforcement of infection control procedures and re-education of the barbers. CONCLUSIONS These results highlight the risk of postoperative infections related to pre-operative skin preparation, and demonstrate the value of next-generation sequencing tools to expedite outbreak investigations.
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Affiliation(s)
- X Liu
- Chinese PLA Centre for Disease Control and Prevention, Beijing, China
| | - Z Yan
- Department of Disease Prevention and Control, The Second Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - L Ye
- Department of Laboratory Medicine, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - K Wang
- Chinese PLA Centre for Disease Control and Prevention, Beijing, China
| | - J Li
- Chinese PLA Centre for Disease Control and Prevention, Beijing, China
| | - Y Lin
- Chinese PLA Centre for Disease Control and Prevention, Beijing, China
| | - C Liao
- Chinese PLA Centre for Disease Control and Prevention, Beijing, China; School of Public Health, China Medical University, Shenyang, China
| | - Y Liu
- Department of Disease Prevention and Control, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - P Li
- Chinese PLA Centre for Disease Control and Prevention, Beijing, China.
| | - M Du
- Department of Disease Prevention and Control, The First Medical Centre of Chinese PLA General Hospital, Beijing, China.
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Vega J, Rodriguez CH, Viscardi I, Vay C, Torres S, Tabares E, Famiglietti A, Nastro M. First nosocomial outbreak of SME-4-producing Serratia marcescens in South America. Rev Argent Microbiol 2023; 55:251-254. [PMID: 37100682 DOI: 10.1016/j.ram.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/17/2022] [Accepted: 02/17/2023] [Indexed: 04/28/2023] Open
Abstract
Carbapenemase-producing-Serratia marcescens isolates, although infrequent, are considered important nosocomial pathogens due to their intrinsic resistance to polymyxins, which limits therapeutic options. We describe a nosocomial outbreak of SME-4-producing S. marcescens in Buenos Aires city which, in our knowledge, represents the first one in South America.
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Affiliation(s)
- Juana Vega
- Servicio de Microbiologia, Departamento de Bioquimica, Hospital General 601-Hospital Militar Central "Cir My Dr Cosme Argerich", Argentina; Laboratorio de Bacteriología, Departamento de Bioquímica Clínica, Hospital de Clínicas José de San Martín, Facultad de Farmacia y Bioquímica, UBA, Argentina.
| | - Carlos H Rodriguez
- Laboratorio de Bacteriología, Departamento de Bioquímica Clínica, Hospital de Clínicas José de San Martín, Facultad de Farmacia y Bioquímica, INFIBIOC, UBA, Argentina
| | - Ignacio Viscardi
- Servicio de Microbiologia, Departamento de Bioquimica, Hospital General 601-Hospital Militar Central "Cir My Dr Cosme Argerich", Argentina
| | - Carlos Vay
- Laboratorio de Bacteriología, Departamento de Bioquímica Clínica, Hospital de Clínicas José de San Martín, Facultad de Farmacia y Bioquímica, INFIBIOC, UBA, Argentina
| | - Silvina Torres
- Servicio de Microbiologia, Departamento de Bioquimica, Hospital General 601-Hospital Militar Central "Cir My Dr Cosme Argerich", Argentina
| | - Emilce Tabares
- Servicio de Microbiologia, Departamento de Bioquimica, Hospital General 601-Hospital Militar Central "Cir My Dr Cosme Argerich", Argentina
| | - Angela Famiglietti
- Laboratorio de Bacteriología, Departamento de Bioquímica Clínica, Hospital de Clínicas José de San Martín, Facultad de Farmacia y Bioquímica, INFIBIOC, UBA, Argentina
| | - Marcela Nastro
- Laboratorio de Bacteriología, Departamento de Bioquímica Clínica, Hospital de Clínicas José de San Martín, Facultad de Farmacia y Bioquímica, INFIBIOC, UBA, Argentina.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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Millán-Lou MI, López C, Bueno J, Pérez-Laguna V, Lapresta C, Fuertes ME, Rite S, Santiago M, Romo M, Samper S, Cebollada A, Oteo-Iglesias J, Rezusta A. Successful control of Serratia marcescens outbreak in a neonatal unit of a tertiary-care hospital in Spain. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:248-254. [PMID: 35577443 DOI: 10.1016/j.eimce.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/06/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Serratia marcescens is a Gram-negative bacterium that is found in hospital environments and commonly associated with outbreaks in neonatal units. One S. marcescens isolate was detected from a bloodstream culture from a neonate in our hospital that was followed by an outbreak. The aim of this study was to describe the molecular epidemiology of a S. marcescens outbreak in the neonatal unit. METHODS In order to investigate the outbreak, weekly surveillance rectal swabs were submitted for culture from all patients admitted in this unit from August to September 2018. Environmental samples were obtained from potential sources in September 2018. Typing of isolates was performed by pulsed field gel electrophoresis (PFGE). In addition, we studied the in vitro activity of chlorhexidine against S. marcescens. RESULTS During this period, 146 infants were hospitalised in our neonatal unit, of which 16 patients had a S. marcescens-positive sample. A total of 36 environmental surveillance samples were collected, and one sample from a stethoscope from an incubator of a colonized baby was positive for S. marcescens. All the 18 isolates, including the isolate from the stethoscope, belonged to a single PFGE cluster. We found that very low concentrations of chlorhexidine, even with application times close to 0 achieved significant reductions in the amount of S. marcescens. CONCLUSION A unique clone of S. marcescens caused this outbreak, including isolates from patients and from one stethoscope. The outbreak was controlled with the early implementation of specific control measures.
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Affiliation(s)
- María Isabel Millán-Lou
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
| | - Concepción López
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Jessica Bueno
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Vanesa Pérez-Laguna
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
| | - Carlos Lapresta
- Servicio de Medicina Preventiva, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - María Elena Fuertes
- Unidad de neonatología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Segundo Rite
- Unidad de neonatología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Mónica Santiago
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - María Romo
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Sofia Samper
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Alberto Cebollada
- CIBERES, ISCIII, Madrid, Spain; Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain; Unidad de Biocomputación, Instituto Aragonés de Ciencias de la Salud (IACS/IIS Aragón), Zaragoza, Spain
| | - Jesús Oteo-Iglesias
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Rezusta
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain
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Jimenez A, Abbo LM, Martinez O, Shukla B, Sposato K, Iovleva A, Fowler EL, McElheny CL, Doi Y. KPC-3-Producing Serratia marcescens Outbreak between Acute and Long-Term Care Facilities, Florida, USA. Emerg Infect Dis 2021; 26:2746-2750. [PMID: 33079055 PMCID: PMC7588513 DOI: 10.3201/eid2611.202203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We describe an outbreak caused by Serratia marcescens carrying blaKPC-3 that was sourced to a long-term care facility in Florida, USA. Whole-genome sequencing and plasmid profiling showed involvement of 3 clonal lineages of S. marcescens and 2 blaKPC-3-carrying plasmids. Determining the resistance mechanism is critical for timely implementation of infection control measures.
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10
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Chen X, Chughtai AA, MacIntyre CR. Recalibration of the Grunow-Finke Assessment Tool to Improve Performance in Detecting Unnatural Epidemics. Risk Anal 2019; 39:1465-1475. [PMID: 30582887 DOI: 10.1111/risa.13255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/01/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
Successful identification of unnatural epidemics relies on a sensitive risk assessment tool designed for the differentiation between unnatural and natural epidemics. The Grunow-Finke tool (GFT), which has been the most widely used, however, has low sensitivity in such differentiation. We aimed to recalibrate the GFT and improve the performance in detection of unnatural epidemics. The comparator was the original GFT and its application in 11 historical outbreaks, including eight confirmed unnatural outbreaks and three natural outbreaks. Three steps were involved: (i) removing criteria, (ii) changing weighting factors, and (iii) adding and refining criteria. We created a series of alternative models to examine the changes on the parameter likelihood of unnatural outbreaks until we found a model that correctly identified all the unnatural outbreaks and natural ones. Finally, the recalibrated GFT was tested and validated with data from an unnatural and natural outbreak, respectively. A total of 238 models were tested. Through the removal of criteria, increasing or decreasing weighting factors of other criteria, adding a new criterion titled "special insights," and setting a new threshold for likelihood, we increased the sensitivity of the GFT from 38% to 100%, and retained the specificity at 100% in detecting unnatural epidemics. Using test data from an unnatural and a natural outbreak, the recalibrated GFT correctly classified their etiology. The recalibrated GFT could be integrated into routine outbreak investigation by public health institutions and agencies responsible for biosecurity.
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Affiliation(s)
- Xin Chen
- Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Chandini Raina MacIntyre
- Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- College of Public Service and Community Solutions, and College of Health Solutions, Arizona State University, Tempe, AZ, USA
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Hervé B, Chomali M, Gutiérrez C, Luna M, Rivas J, Blamey R, Espinoza R, Izquierdo G, Cabezas C, Alvarez C, de la Fuente S. [Outbreak due to Serratia marcescens associated with intrinsic contamination of aqueous chlorhexidine]. Rev Chilena Infectol 2016; 32:517-22. [PMID: 26633107 DOI: 10.4067/s0716-10182015000600004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/10/2015] [Indexed: 11/17/2022] Open
Abstract
Serratia marcescens is a widely distributed gram-negative rod, often associated to nosocomial infections. Some outbreaks linked to contaminated antiseptic solutions have been reported. In this study we report a nosocomial outbreak of surgical site infection and catheter insertion site infection due to S. marcescens. 33 patients with positive cultures were studied after an index case was identified. Epidemiological, microbiological and molecular analysis demostrated an intrinsic contamination of alcohol free chlorhexidine solution as causal factor. Positive cultures were associated with 13 clinical infections, 9 colonized patients, 6 pseudobacteremia episodes and 5 patients without documented exposure. Hospital and national recall of contaminated chlorhexidine solution was performed after this study. Intrinsic contamination of antiseptic solutions is an infrequent cause of nosocomial infections with major epidemiological relevance.
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13
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Lai KK, Baker SP, Fontecchio SA. Rapid Eradication of a Cluster ofSerratia marcescensin a Neonatal Intensive Care Unit: Use of Epidemiologic Chromosome Profiling by Pulsed-Field Gel Electrophoresis. Infect Control Hosp Epidemiol 2015; 25:730-4. [PMID: 15484796 DOI: 10.1086/502468] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To investigate a cluster of patients infected and colonized withSerratia marcescensin a neonatal intensive care unit (NICU).Methods:In June 2001, two neonates in the NICU had clinical infections withS. marcescensand one died. Infection control surveillance data for the NICU revealed that S.marcescenswas rarely isolated from clinical specimens. Surveillance and environmental cultures were performed and isolates were typed using pulsed-field gel electrophoresis. Staff and neonates were cohorted and a waterless, alcohol-based handwashing agent was introduced. A case-control study was performed.Results:From June 2 through August 20, 2001, 11 neonates withS. marcescensinfection and colonization were identified. The incidence ofS. marcescensinfections increased from 0.19 per 1,000 patient-days in 2000 to 0.52 per 1,000 patient-days in 2001 (P< .0001). In the first 3 weeks of the investigation, there were 2 sets of patients and sinks with indistinguishable strains; however, in subsequent weeks, all isolates were of unique strains, signifying no further transmission of the two initial predominant strains. Neonates withS. marcescenswere more likely to have a lower gestational age and birth weight. There was no association between cases and healthcare workers (HCWs).Conclusions:A cluster ofS. marcescenswas quickly terminated after the introduction of preventive measures including cohorting of infected and colonized neonates and HCWs, contact precautions, surveillance cultures, and a waterless, alcohol-based hand antiseptic. Chromosomal typing determined that strains with an indistinguishable pattern were no longer present in the unit after control measures were implemented.
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Affiliation(s)
- Kwan Kew Lai
- UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655, USA
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14
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Takahashi H, Kramer MH, Yasui Y, Fujii H, Nakase K, Ikeda K, Imai T, Okazawa A, Tanaka T, Ohyama T, Okabe N. Nosocomial Serratia marcescens Outbreak in Osaka, Japan, From 1999 to 2000. Infect Control Hosp Epidemiol 2015; 25:156-61. [PMID: 14994942 DOI: 10.1086/502367] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjectives:To investigate and control an outbreak of bloodstream infections (BSIs) caused by Serratia marcescens and to identify risk factors for respiratory colonization or infection with S. marcescens.Design:Epidemiologic investigation, including review of medical and laboratory records, procedural investigations, pulsed-field gel electrophoresis (PFGE) typing of environmental and patient isolates, statistical study, and recommendation of control measures.Patients and Setting:All patients admitted to a 380-bed, secondary-care hospital in Osaka Prefecture, Japan, from July 1999 through June 2000 (study period).Results:Seventy-one patients were colonized or infected with S. marcescens; 3 patients who developed primary BSIs on the same ward within 5 days in June 2000 had isolates with indistinguishable PFGE patterns and indwelling intravenous catheters for more than 5 days. On multivariate analysis, among 36 case-patients with positive sputum specimens and 95 control-patients, being bedridden (odds ratio [OR], 15.91; 95% confidence interval [CI95], 4.17-60.77), receiving mechanical ventilation (OR, 7.86; CI95, 2.27-27.16), being older than 80 years (OR, 3.12; CI95, 1.05-9.27), and receiving oral cleaning care (OR 3.10; CI95, 1-9.58) were significant risk factors. S. marcescens was isolated from the fluid tanks of three nebulizers and a liquid soap dispenser. The hospital did not have written infection control standards, and many infection control practices were found to be inadequate (eg, respiratory equipment was used without disinfection between patients).Conclusions:Poor hospital hygiene and the lack of standard infection control measures contributed to infections hospital-wide. Recommendations to the hospital included adoption of written infection control policies.
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Affiliation(s)
- Hiroshi Takahashi
- Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
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15
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Casolari C, Pecorari M, Della Casa E, Cattani S, Venturelli C, Fabio G, Tagliazucchi S, Serpini GF, Migaldi M, Marchegiano P, Rumpianesi F, Ferrari F. Serratia marcescens in a neonatal intensive care unit: two long-term multiclone outbreaks in a 10-year observational study. New Microbiol 2013; 36:373-383. [PMID: 24177299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 07/21/2013] [Indexed: 06/02/2023]
Abstract
We investigated two consecutive Serratia marcescens (S. marcescens) outbreaks which occurred in a neonatal intensive care unit (NICU) of a tertiary level hospital in North Italy in a period of 10 years (January 2003-December 2012). Risk factors associated with S. marcescens acquisition were evaluated by a retrospective case-control study. A total of 21,011 clinical samples was examined: S. marcescens occurred in 127 neonates: 43 developed infection and 3 died. Seven clusters were recorded due to 12 unrelated clones which persisted for years in the ward, although no environmental source was found. The main epidemic clone A sustaining the first cluster in 2003 reappeared in 2010 as an extended spectrum ?-lactamase (ESBL)-producing strain and supporting the second epidemic. Birth weight, gestational age, use of invasive devices and length of stay in the ward were significantly related to S. marcescens acquisition. The opening of a new ward for non-intensive care-requiring neonates, strict adherence to alcoholic hand disinfection, the timely identification and isolation of infected and colonized neonates assisted in containing the epidemics. Genotyping was effective in tracing the evolution and dynamics of the clones demonstrating their long-term persistence in the ward.
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Affiliation(s)
- Chiara Casolari
- Department to Integrated Activity of Laboratory Medicine, Modena, Italy
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16
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Iosifidis E, Farmaki E, Nedelkopoulou N, Tsivitanidou M, Kaperoni M, Pentsoglou V, Pournaras S, Athanasiou-Metaxa M, Roilides E. Outbreak of bloodstream infections because of Serratia marcescens in a pediatric department. Am J Infect Control 2012; 40:11-5. [PMID: 21856046 DOI: 10.1016/j.ajic.2011.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 03/17/2011] [Accepted: 03/18/2011] [Indexed: 01/05/2023]
Abstract
BACKGROUND Serratia marcescens can cause health care-associated infections. We herewith report the investigation and control of an outbreak of S marcescens bloodstream infections (BSI) in a general pediatric department. METHODS From April to May 2009, temporally related cases of S marcescens BSI occurred in a 40-bed general pediatric department of a tertiary care hospital. An outbreak investigation including case identification, review of medical records, environmental cultures, patients' surveillance cultures, personnel hand cultures, pulsed-field gel electrophoresis, and a case-control study were conducted. Controls were patients without S marcescens BSI but hospitalized in the department for at least 48 hours during the outbreak. Enhanced infection control measures were immediately implemented by the Infection Control Committee. RESULTS During the study period, 4 patients developed BSI because of a S marcescens strain demonstrating the same antimicrobial susceptibility pattern as well as the same molecular profile. Patients' surveillance cultures and personnel hand cultures were negative. In 1 case-patient, S marcescens grew from cultures of intravenous infusion systems. In the case-control study performed, there were no differences in demographics, intravenously administered medications, or place of hospital stay. Case patients had changes in vascular access significantly more frequently than controls. No S marcescens infections occurred in the department during the 18 months following implementation of the enhanced infection control measures. CONCLUSION Prompt recognition and strict adherence to infection control measures are of paramount importance in combating an outbreak of S marcescens bloodstream infection.
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Affiliation(s)
- Elias Iosifidis
- Third Department of Pediatrics, Aristotle University, Thessaloniki, Greece
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17
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Abstract
At the interface of molecular biology and epidemiology, the emerging discipline of molecular epidemiology offers unique opportunities to advance the study of diseases through the investigation of infectious agents at the molecular level. Molecular tools can increase our understanding of the factors that shape the spatial and temporal distribution of pathogens and disease. Both spatial and molecular aspects have always been important to the field of infectious disease epidemiology, but recently news tools have been developed which increase our ability to consider both elements within a common framework. This enables the epidemiologist to make inferences about disease patterns in space and time. This paper introduces some basic concepts of molecular epidemiology in a veterinary context and illustrates the application of molecular tools at a range of spatio-temporal scales. Case studies - a multi-state outbreak of Serratia mastitis, a national control program for campylobacteriosis, and evolution of foot-and-mouth-disease viruses - are used to demonstrate the importance of considering molecular aspects in modern epidemiological studies. The discipline of molecular epidemiology is in its infancy and our contribution aims to promote awareness, understanding and uptake of molecular epidemiology in veterinary science.
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Affiliation(s)
- Petra Muellner
- Epi-interactive, 8a Darlington Road, Miramar, Wellington 6022, New Zealand.
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18
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Ohnishi M, Sawada T, Hirose K, Sato R, Hayashimoto M, Hata E, Yonezawa C, Kato H. Antimicrobial susceptibilities and bacteriological characteristics of bovine Pseudomonas aeruginosa and Serratia marcescens isolates from mastitis. Vet Microbiol 2011; 154:202-7. [PMID: 21783330 DOI: 10.1016/j.vetmic.2011.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 06/18/2011] [Accepted: 06/23/2011] [Indexed: 11/17/2022]
Abstract
The presence of metallo-β-lactamase (MBL)-producing and multidrug-resistant Pseudomonas aeruginosa (MDRP) strains among bovine isolates of Gram-negative bacilli, and O-serotypes of bovine Serratia marcescens and P. aeruginosa isolates have been reported rarely. The aims of this study were to (1) elucidate antimicrobial susceptibilities and O-serotypes of P. aeruginosa and S. marcescens isolates from bovine mastitis and the presence of MBL-producers and MDRP strains among them and (2) evaluate their relationships to human isolates. We investigated the MICs of 24 antimicrobials and O-serotypes for 116 P. aeruginosa and 55 S. marcescens isolates in Japan, primarily in 2006. A total of 171 isolates exhibited high antimicrobial susceptibilities with the exception of a partial drug. P. aeruginosa isolates exhibited high susceptibilities of ≥ 95.7% to ciprofloxacin, imipenem, meropenem, piperacillin, ceftazidime, cefepime, cefoperazone/sulbactam, amikacin, tobramycin, and gentamicin; however, they exhibited a susceptibility of only 69.8% to aztreonam. They exhibited substantial resistances to ceftriaxone, enrofloxacin, cefotaxime, and moxalactam. S. marcescens isolates exhibited high susceptibilities of ≥ 90.9% to kanamycin, ceftiofur, sulfamethoxazole-trimethoprim, and the 15 aforementioned drugs, but exhibited resistance to minocycline. Neither MBL-producers nor MDRP strains were detected among the 171 strains. The dominant serotypes of P. aeruginosa isolates were OG, OA, OB, OI, OF, OE, and OK; those of S. marcescens isolates were O6 and O5. Every S. marcescens isolate was pigmented. These findings suggest that bovine P. aeruginosa and S. marcescens isolates differ from human isolates from both antibiogram and phenotypic perspectives, and could help to evaluate differences in bacteriological characteristics between bovine and human isolates.
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Affiliation(s)
- Mamoru Ohnishi
- Veterinary Clinical Laboratory, Nemuro District Agricultural Mutual Aid Association, Nakashibetsu, Hokkaido 086-1105, Japan.
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19
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Samonis G, Vouloumanou EK, Christofaki M, Dimopoulou D, Maraki S, Triantafyllou E, Kofteridis DP, Falagas ME. Serratia infections in a general hospital: characteristics and outcomes. Eur J Clin Microbiol Infect Dis 2011; 30:653-60. [PMID: 21222011 DOI: 10.1007/s10096-010-1135-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 12/17/2010] [Indexed: 02/06/2023]
Abstract
We aimed to present our experience regarding infections caused by Serratia spp. in a region with relatively high antimicrobial resistance rates. We retrospectively reviewed the databases of the microbiological laboratory of the University Hospital of Heraklion, Crete (2/2004-12/2009). A total of 77 patients [67.5% men, mean age ± standard deviation (SD) = 56.9 ± 24.5 years) were identified; 37.7% were outpatients. Sixty-five (84.4%) of the 77 included patients had a Serratia marcescens isolate; the remaining 12 patients had a non-marcescens Serratia spp. The most frequently observed infections were respiratory tract infection (32.5%) and keratitis/endophthalmitis (20.8%). Seventy-three (94.9%) patients were cured. Four deaths were observed; three of them were considered as attributed to the Serratia infection. No difference was found regarding the characteristics and outcomes between patients with Serratia marcescens and non-marcescens infections. In addition, antipseudomonal penicillins and their combinations with beta-lactamase inhibitors, as well as carbapenemes, and fluoroquinolones exhibited high antimicrobial activity against both the tested Serratia marcescens and non-marcescens isolates. Our study adds useful information regarding the characteristics and outcomes of patients with Serratia infection, as well as the susceptibilities of the respective Serratia marcescens and non-marcescens isolates, in a region with relatively high levels of antimicrobial resistance.
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Affiliation(s)
- G Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
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20
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Herruzo Cabrera R. [Epidemic of Serratia marcescens in a tertiary neonatal intensive care unit: multivariate analysis of risk factors in a case-control study]. An R Acad Nac Med (Madr) 2011; 128:739-749. [PMID: 23350314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
An epidemic of Serratia marcescens was studied in a neonatal intensive care unit in a tertiary hospital by evaluating both infections and colonizations by this microorganism. Over a 14-month period, 26 infants were infected with S. marcescens (bacteriemias or bronchopneumonias). All the S. marcescens isolates studied by PFGE were identical, although their antimicrobial resistance varied. No environmental reservoirs were found. In the concurrent case-control study, the risk factors for infection were stay of more than 1 month, mechanical ventilation and anemia.
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21
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Ktari S, Mahjoubi F, Mnif B, Kallel H, Bouaziz M, Hammami A. [Investigation of three nosocomial outbreaks of Serratia marcescens in an intensive care unit in Sfax-Tunisia]. Tunis Med 2010; 88:501-506. [PMID: 20582888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED THE AIM of the study was to type Serratia marcescens responsible for nosocomial outbreaks in an intensive care unit in Sfax -Tunisia. METHODS The relatedness between S. marcescens isolates was studied by Pulsed field gel electrophoresis (PFGE). We included 56 strains of Serratia marcescens isolated from patients hospitalized in the intensive care unit during 2003 and 2004. Seven epidemiological unrelated strains of Serratia marcescens were also tested. Samples from environment and hands of the nursing and medical staff were collected and cultured to identify the source of contamination. RESULTS All strains showed a wild type of antimicrobial susceptibility. PFGE typing revealed that three different clones were present. None of the cultures taken from hands of unit staff and from environmental samples yielded positive results for S. marcescens. CONCLUSION We have confirmed the presence of three consecutive outbreaks caused by three genetically unrelated bacterial clones of Serratia marcescens in the intensive care unit ward. These outbreaks are closely related to the frequent use of colistin and the lack of measures of hygiene in this ward.
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Affiliation(s)
- Sania Ktari
- Service de Microbiolgie, Habib Bourguiba de Sfax-Tunisie
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22
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Chemaly RF, Rathod DB, Raad II. A tertiary care cancer center experience of the 2007 outbreak of Serratia marcescens bloodstream infection due to prefilled syringes. Infect Control Hosp Epidemiol 2010; 30:1237-8. [PMID: 19888846 DOI: 10.1086/648661] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Dundar D, Meric M, Vahaboglu H, Willke A. Pseudo-outbreak of Serratia marcescens in a tertiary care hospital. New Microbiol 2009; 32:273-276. [PMID: 19845109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The aim of this study was to describe a pseudo-outbreak due to Serratia marcescens associated with laboratory contamination, and also the epidemiologic and laboratory methods used to determine the source of contamination. An apparent increase in positive culture results for Serratia marcescens was observed in the Clinical Microbiology Laboratory of Kocaeli University Hospital between September and November 2007. An outbreak investigation including retrospective and prospective studies using chart review, environmental sampling and random arbitrary polymorphic DNA-polymerase chain reaction (RAPD-PCR) of randomly selected isolates were performed by the Infection Control Committee. Nine out of 67 strains belonged to a real infection. S. marcescens was also isolated from saline solution in the specimen processing area of the laboratory. It was recognized that the technician has been using the same stock saline solution for processing specimens without changing the injector. RAPD patterns of the clinical isolates were identical to the pattern of saline strain. The contaminated saline solution was discarded, the technician was trained and no additional cases of suspected contamination have been observed. This pseudo-outbreak emphasize the importance of the observation of specimen processing procedures and the training of laboratory workers.
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Affiliation(s)
- Devrim Dundar
- Medical Faculty of Kocaeli University, Department of Clinical Microbiology, Kocaeli, Turkey.
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24
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Guler E, Davutoglu M, Ucmak H, Karabiber H, Kokoglu OF. An outbreak of Serratia marcescens septicemia in neonates. Indian Pediatr 2009; 46:61-63. [PMID: 19179721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Serratia marcescens is a well recognized nosocomial pathogen. We report an outbreak with this organism in 8 neonates in a neonatal intensive care unit (NICU). Seven cases were treated successfully with meropenem after the failure of imipenem treatment. Although they have similar anti-microbial effects, meropenem can effectively treat the S. marcescens sepsis resistant to imipenem.
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Affiliation(s)
- Ekrem Guler
- Department of Pediatric, Kahramanmaras Sutcu Imam University, Kahramanmaras 46050, Turkey.
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25
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Abstract
OBJECTIVE To describe an outbreak of Serratia marcescens infections in a neonatal intensive care unit (NICU) and to report investigations and interventions having led to the cessation of the outbreak. DESIGN Observational study of microbiological and epidemiological investigations realised during a S. marcescens outbreak between March and October 2006. METHODS Nine cases were observed in a 5 months period. A Serratia outbreak was therefore identified, and all the strains were compared by pulsed-field gel electrophoresis (PFGE). Data from medical notes were gathered retrospectively. Environmental samples were gathered prospectively. RESULTS Four infants were colonized and five infants were infected by S. marcescens. PFGE revealed that three different strains were present. Seven of the nine babies were infected by only one of these strains. This same strain was found in a nonantimicrobial soap bottle (NAS) that could be the source of contamination. CONCLUSION It is the first time that S. marcescens is found in a NAS during a neonatal nosocomial outbreak. Molecular analysis is a method of choice to compare different strains. Identification and elimination of the nosocomial source and adherence to the infection control policies are essential to succeed in the containment of a nosocomial epidemic.
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Affiliation(s)
- V Rabier
- Service de maladies infectieuses et tropicales, CHU d'Angers, Université d'Angers, Angers, France.
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Crivaro V, Bagattini M, Salza MF, Raimondi F, Rossano F, Triassi M, Zarrilli R. Risk factors for extended-spectrum beta-lactamase-producing Serratia marcescens and Klebsiella pneumoniae acquisition in a neonatal intensive care unit. J Hosp Infect 2007; 67:135-41. [PMID: 17884248 DOI: 10.1016/j.jhin.2007.07.026] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 07/26/2007] [Indexed: 01/11/2023]
Abstract
We investigated the molecular epidemiology of gentamicin-resistant, extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae and Serratia marcescens, and risk factors associated with their acquisition in a neonatal intensive care unit (NICU) of a university hospital in Italy. During the study period (April-November 2004), S. marcescens was responsible for six infections and 31 colonisations, while K. pneumoniae was responsible for six infections and 103 colonisations. Concurrent isolation of both organisms occurred in 24 neonates. Molecular typing identified one major pulsed-field gel electrophoresis pattern each for S. marcescens and K. pneumoniae strains isolated during the study period. An 80 kb plasmid containing bla(SHV-12), bla(TEM-1) and aac(6')-Ib genes, isolated from both S. marcescens and K. pneumoniae strains, and showing identical restriction profiles, transferred resistance to third-generation cephalosporins to a previously susceptible Escherichia coli host. Birthweight, gestational age and use of invasive devices were significantly associated with S. marcescens and K. pneumoniae acquisition on univariate analysis, while empiric antimicrobial treatment with ampicillin and gentamicin, and duration of hospital stay, proved to be the only independent risk factors. In conclusion, conjugal plasmid transfer and empiric antimicrobial therapy with ampicillin and gentamicin might have contributed to the selection and spread of gentamicin-resistant ESBL-producing Enterobacteriaceae in the NICU.
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Affiliation(s)
- V Crivaro
- Department of Preventive Medical Sciences, Hygiene Section, University Federico II, Naples, Italy
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Sunenshine RH, Tan ET, Terashita DM, Jensen BJ, Kacica MA, Sickbert-Bennett EE, Noble-Wang JA, Palmieri MJ, Bopp DJ, Jernigan DB, Kazakova S, Bresnitz EA, Tan CG, McDonald LC. A multistate outbreak of Serratia marcescens bloodstream infection associated with contaminated intravenous magnesium sulfate from a compounding pharmacy. Clin Infect Dis 2007; 45:527-33. [PMID: 17682984 DOI: 10.1086/520664] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 05/10/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In contrast to pharmaceutical manufacturers, compounding pharmacies adhere to different quality-control standards, which may increase the likelihood of undetected outbreaks. In 2005, the Centers for Disease Control and Prevention received reports of cases of Serratia marcescens bloodstream infection occurring in patients who underwent cardiac surgical procedures in Los Angeles, California, and in New Jersey. An investigation was initiated to determine whether there was a common underlying cause. METHODS A matched case-control study was conducted in Los Angeles. Case record review and environmental testing were conducted in New Jersey. The Centers for Disease Control and Prevention performed a multistate case-finding investigation; isolates were compared using pulsed-field gel electrophoresis analysis. RESULTS Nationally distributed magnesium sulfate solution (MgSO(4)) from compounding pharmacy X was the only significant risk factor for S. marcescens bloodstream infection (odds ratio, 6.4; 95% confidence interval, 1.1-38.3) among 6 Los Angeles case patients and 18 control subjects. Five New Jersey case patients received MgSO(4) from a single lot produced by compounding pharmacy X; culture of samples from open and unopened 50-mL bags in this lot yielded S. marcescens. Seven additional case patients from 3 different states were identified. Isolates from all 18 case patients and from samples of MgSO(4) demonstrated indistinguishable pulsed-field gel electrophoresis patterns. Compounding pharmacy X voluntarily recalled the product. Neither the pharmacy nor the US Food and Drug Administration could identify a source of contamination in their investigations of compounding pharmacy X. CONCLUSIONS A multistate outbreak of S. marcescens bloodstream infection was linked to contaminated MgSO(4) distributed nationally by a compounding pharmacy. Health care personnel should take into account the different quality standards and regulation of compounded parenteral medications distributed in large quantities during investigations of outbreaks of bloodstream infection.
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Affiliation(s)
- Rebecca H Sunenshine
- Centers for Disease Control and Prevention, Arizona Dept. of Health Services, 150 N. 18th Ave., Ste. 150, Phoenix, AZ 85007, USA.
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Abstract
Colonization of neonatal intensive care units by Serratia marcescens is associated with clinical outbreaks. We report the management of an outbreak in a newborn services unit (NBS), in 2004, of a strain of S. marcescens that was present in the unit from 1994. Over the 10-year period, increases in clinical isolates demonstrated three epidemic curves, each spanning 3-4 years and each involving positive blood cultures. In 2004, clinical isolates of S. marcescens bacteremia prompted an investigation. Control measures including screening, creation of a separate unit, use of contact precautions, education, environmental sampling, strategies to reduce overcrowding, surveillance and molecular epidemiological techniques were implemented. In total, 99 babies were either colonized or infected with S. marcescens between December 2003 and December 2005. Isolates were tested with ribotyping identifying one main endemic strain. No environmental source was found, however, the outbreak terminated following adherence to infection control principles. Epidemiological information, structural and practice changes were used to prevent transmission and control the outbreak.
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Abstract
A swallow-tailed hummingbird (Eupetomena macroura) was presented with a history of prostration and inability to fly. After a 2-day hospitalization, the bird died and necropsy findings included diffuse hyperemia of the small intestine serosal and mucosal surfaces and the presence of a small quantity of clear ascitic fluid in the coelomic cavity. Intestinal contents and cardiac blood were collected for microbiologic exams yielding pure cultures of a pigmented strain of Serratia marcescens. This strain was susceptible to gentamicin, enrofloxacin, streptomycin, trimethoprim, and sulfamethoxazole and had intermediate susceptibility to chloramphenicol and resistance to cephalotin. The source of the infection could not be ascertained, but possible contamination of hummingbird feeders could be involved, because the infection seemed to originate from the digestive tract.
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Affiliation(s)
- André B S Saidenberg
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo - SP, Brazil
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Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG. Case-control analysis of endemic Serratia marcescens bacteremia in a neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2007; 92:F120-6. [PMID: 17088342 PMCID: PMC2675455 DOI: 10.1136/adc.2006.102855] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Serratia marcescens is an opportunistic gram-negative rod which typically infects compromised hosts. OBJECTIVES To identify risk factors, signs, and outcomes associated with non-epidemic S marcescens bacteremia in a neonatal intensive care unit (NICU). METHODS The records of infants with S marcescens bacteremia while in the Yale-New Haven Hospital NICU from 1980-2004 were reviewed. A matched case-control study was performed by comparing each case of S marcescens to 2 uninfected controls and 2 cases of Escherichia coli bacteremia. RESULTS Twenty-five sporadic cases of S marcescens bacteremia were identified. Eleven available isolates were determined to be different strains by pulse field gel electrophoresis. Infants with S marcescens bacteremia had median gestational age and birth weight of 28 weeks and 1235 grams, respectively. Compared to matched, uninfected controls, infants with S marcescens bacteremia were more likely to have had a central vascular catheter (OR = 4.33; 95% CI (1.41 to 13.36)) and surgery (OR = 5.67; 95% CI (1.81 to 17.37)), and had a higher overall mortality (44% vs 2%; OR = 38.50; 95% CI (4.57 to 324.47)). Compared to E coli matched controls, infants with S marcescens bacteremia had later onset of infection (median of 33 days of life vs 10; p<0.001), prolonged intubation (OR = 5.76; 95% CI (1.80 to 18.42)), and a higher rate of CVC (OR = 7.77; 95% CI (2.48 to 24.31)) use at the time of infection. A higher rate of meningitis (24% vs 7%; OR = 3.98; 95% CI (1.09 to 14.50)) was observed with S marcescens bacteremia compared to E coli. CONCLUSIONS S marcescens bacteremia occurs sporadically in the NICU, primarily in premature infants requiring support apparatus late in their hospital course. Associated meningitis is common and mortality high.
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Affiliation(s)
- Matthew J Bizzarro
- Divisions of Perinatal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA
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Yanagawa Y, Marumo K, Nakamura Y, Shimamura T. Isolation rate of non-hemagglutinating strains of Serratia marcescens from clinical specimens in a general hospital: comparison of serotypes O2 and O14. J Infect Chemother 2007; 13:151-6. [PMID: 17593501 DOI: 10.1007/s10156-007-0511-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 02/07/2007] [Indexed: 10/23/2022]
Abstract
Given the absence of recent reports on the isolation rate of Serratia marcescens by pili type, clinical isolates from respiratory and urinary tract specimens--prime loci of infection by this organism--were subjected to examination. The 123 S. marcescens strains (serotype O2, 67 strains, serotype O14, 56 strains) used in this study were isolated from inpatients at Showa University Fujigaoka Hospital during the 5 years from April 1997 to March 2002. Higher rates of S. marcescens O2 with mannose-resistant (MR)/K Klebsiella-like pili were detected among the respiratory tract-derived strains. On the other hand, more non-hemagglutinating O14 strains were found among the urinary tract-derived strains. Analysis by study phase revealed a rise in the isolation rate of non-hemagglutinating strains, from 0-17.4% for O2 strains and 34.5%-66.7% for O14 strains, between phase I (April 1997 to March 1999) and phase II (April 1999 to March 2002) of the study. In order to examine the increasing non-hemagglutinating strains in detail, the 28 serotype O14 non-hemagglutinating strains, and 8 strains with only mannose-sensitive (MS) pili were subjected to genotyping by pulsed-field gel electrophoresis (PFGE), revealing the presence of 10 clones with disparate genotypes. The A1 strain isolated at the highest frequency was non-hemagglutinating in all cases and possessed the same genotype, indicating proliferation within the hospital over the 5 years of the study. These results indicate that non-hemagglutinating strains were transmitted among patients within the hospital.
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Affiliation(s)
- Yoko Yanagawa
- Department of Microbiology and Immunology, Showa University School of Medicine, 1-7-5 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
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Abstract
We report on the investigations and interventions conducted to contain an extended outbreak of Serratia marcescens bacteriuria that lasted for years in a neurosurgical intensive care unit (NSICU). A case-control study was performed to identify the risk factors for S. marcescens acquisition in urine. In case patients, urine sampling for tests and central venous catheterization were performed more frequently before the isolation of S. marcescens. Case patients were more frequently prescribed third-generation cephalosporins. Adherence to hand antisepsis was encouraged through in-service educational meetings and infection control measures, especially concerning the manipulation of indwelling urinary catheters, were intensified. The outbreak persisted despite the reinforcement of infection control measures. However, no patient has newly acquired the organism in the NSICU since December 2004. Multiple factors, including inadequate infection control practices and inappropriate antimicrobial usage, possibly contributed to the persistence of this S. marcescens outbreak. Healthcare workers should consistently follow infection control policies to ensure quality care.
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Affiliation(s)
- Baek-Nam Kim
- Department of Internal Medicine, Inje University, Sanggyepaik Hospital, 761-1 Sanggye 7-Dong, Nowon-Gu, Seoul, Korea.
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de Vries JJC, Baas WH, van der Ploeg K, Heesink A, Degener JE, Arends JP. Outbreak of Serratia marcescens colonization and infection traced to a healthcare worker with long-term carriage on the hands. Infect Control Hosp Epidemiol 2006; 27:1153-8. [PMID: 17080370 DOI: 10.1086/508818] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2005] [Accepted: 09/08/2005] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To reveal the source of a nosocomial outbreak of colonization and infection with a strain of Serratia marcescens positive for Guiana extended-spectrum beta-lactamase 1 (GES-1) that occurred among patients in a neurosurgical intensive care unit (ICU) in a Dutch university medical center from May 2002 through March 2003. METHODS Samples from the environment and from the hands of healthcare workers (HCWs) were cultured. A retrospective case-control study was carried out. RESULTS Fifteen neurosurgical ICU patients who had 1 or more cultures that yielded the epidemic strain of S. marcescens from May 2002 through March 2003 were defined as case patients and matched with 30 control patients. Environmental cultures did not reveal a prominent source of S. marcescens. Cultures of specimens from the hands of 100 HCWs revealed colonization of a single HCW with the epidemic strain. Although this HCW instantly went on leave, serial cultures detected prolonged carriage of the epidemic strain on the hands of the HCW for 3 months. The skin of the HCW's hands was psoriatic. The epidemic abruptly ended after the colonized HCW went on leave. Retrospective case-control analysis showed that the patients colonized or infected with S. marcescens received significantly more nursing care from the colonized HCW than did control patients (P<.05). From February 2004 through October 2004, a second cluster of 3 patients was detected with the epidemic strain of S. marcescens. In October 2004, the formerly colonized HCW appeared to have carriage of the epidemic strain on the hands again. CONCLUSIONS A single HCW with the epidemic strain of S. marcescens on the hands was considered the source of this outbreak.
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Affiliation(s)
- Jutte J C de Vries
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, The Netherlands.
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Civen R, Vugia DJ, Alexander R, Brunner W, Taylor S, Parris N, Wasserman R, Abbott S, Werner SB, Rosenberg J. Outbreak of Serratia marcescens infections following injection of betamethasone compounded at a community pharmacy. Clin Infect Dis 2006; 43:831-7. [PMID: 16941362 DOI: 10.1086/507336] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 05/10/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In June 2001, following the report of 4 patients with Serratia marcescens meningitis who received epidural injections of betamethasone compounded at a community pharmacy, we initiated an outbreak investigation. METHODS All patients who received injections of betamethasone from the production lot common to the 4 patients were evaluated. A case patient was defined as a patient who received compounded betamethasone and had S. marcescens isolated from a sterile site or clinical and laboratory evidence of infection. We cultured all recovered betamethasone, environmental specimens from the pharmacy, and medications recovered from an ambulatory surgery center. The California Board of Pharmacy reviewed the procedures used to prepare the betamethasone. RESULTS We identified 11 patients with culture-confirmed S. marcescens (8 patients) or clinical infection (3 patients) following injection of compounded betamethasone from 25 May through 31 May 2001. Case patients had meningitis (5 patients, with 3 deaths), epidural abscesses (5 patients), or an infected hip (1 patient). S. marcescens was isolated from 35 (69%) of 51 betamethasone vials recovered, from pharmacy specimens of 1% carboxymethylcellulose stock solution, from pharmacy surfaces, and from multiple parenteral materials used at the ambulatory surgery center. Pulsed-field gel electrophoresis patterns of S. marcescens isolates of representative specimens from patients, the betamethasone, the pharmacy, and the ambulatory surgery center were identical. Deficient practices in compounding of betamethasone included inadequate autoclaving temperatures and failure to perform terminal sterilization. CONCLUSIONS This outbreak of serious S. marcescens infection followed improper compounding of betamethasone in a community pharmacy. Enforceable national standards for pharmaceutical compounding are needed to reduce the risk of such outbreaks.
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Affiliation(s)
- Rachel Civen
- Los Angles County Department of Health Services, Acute Communicable Disease Control Program, Los Angeles, CA 90012, USA.
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35
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Jepson AP, McDougall C, Clark A, Bateman A, Williamson G, Kaufmann ME. Finger rings should be removed prior to scrubbing. J Hosp Infect 2006; 64:197-8. [PMID: 16890324 DOI: 10.1016/j.jhin.2006.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 05/30/2006] [Indexed: 11/22/2022]
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Horcajada JP, Martínez JA, Alcón A, Marco F, De Lazzari E, de Matos A, Zaragoza M, Sallés M, Zavala E, Mensa J. Acquisition of multidrug-resistant Serratia marcescens by critically ill patients who consumed tap water during receipt of oral medication. Infect Control Hosp Epidemiol 2006; 27:774-7. [PMID: 16807859 DOI: 10.1086/504445] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 04/18/2005] [Indexed: 11/03/2022]
Abstract
We describe an outbreak of multidrug-resistant Serratia marcescens infection and colonization involving adults admitted to a surgical intensive care unit. Examination of the outbreak revealed epidemiological evidence that consumption of tap water from a contaminated faucet during receipt of oral medication was the mechanism of S. marcescens acquisition.
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Affiliation(s)
- Juan P Horcajada
- Service of Infectious Diseases, Hospital Clínic Universitari-IDIBAPS, Barcelona, Spain.
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Yatsuyanagi J, Saito S, Konno T, Harata S, Suzuki N, Kato J, Amano KI. Nosocomial outbreak of ceftazidime-resistant Serratia marcescens strains that produce a chromosomal AmpC variant with N235K substitution. Jpn J Infect Dis 2006; 59:153-9. [PMID: 16785694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Serratia marcescens is a Gram-negative bacterium that is often associated with nosocomial infections. Here we analyzed the resistance mechanism of the ceftazidime-resistant S. marcescens nosocomial strains. The five S. marcescens urinary tract infection-associated isolates were positive for chromosomal ampC and bla(TEM-1). Four of the five strains, ES11, ES31, ES42, and ES46, were single clone and ceftazidime resistant. The fifth strain, ES71, was susceptible to ceftazidime. Analysis of the deduced amino acid sequence revealed a Glu-235-Lys substitution in the third amino acid of the third motif of AmpC from both ES46 and ES71, and a site-directed mutagenesis experiment confirmed that this substitution is involved in the ceftazidime resistance phenotype. However, the resistance phenotypes of strains ES46 and ES71 to ceftazidime were quite different from one another, indicating that another mechanism, in addition to the AmpC mutation, is also involved in the determination of the resistance phenotype of these strains. Basal AmpC activity was more than two times higher in strain ES46 than in ES71, which could result in the differing resistance phenotypes of these two strains. The clinical significance and prevalence of extended-spectrum cephalosporin-resistant S. marcescens strains harboring the mutated chromosomal ampC gene are unclear in Japan and remain to be elucidated.
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Affiliation(s)
- Jun Yatsuyanagi
- Akita Prefectural Institute of Public Health, Sensyu kubota-machi, Akita 010-0874, Japan.
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Cheng KC, Chuang YC, Wu LT, Huang GC, Yu WL. Clinical experiences of the infections caused by extended-spectrum beta-lactamase-producing Serratia marcescens at a medical center in Taiwan. Jpn J Infect Dis 2006; 59:147-52. [PMID: 16785693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
CTX-M-3 has become the most common extended-spectrum beta-lactamase (ESBL) produced by Serratia marcescens in Taiwan. An expanded effort to detect ESBL among 123 nonrepetitive isolates of S. marcescens was made and 15 (12%) ESBL-producers were identified, all revealing CTX-M-3. Without routinely detecting the ESBL for S. marcescens in clinical laboratories, 80% of the ESBL-producers were reported to be susceptible to cefepime. The clinical spectrum of ESBL-producing S. marcescens-related infections included febrile urinary tract infection (n = 3); afebrile pyuria (n = 2); pneumonia (n = 3); spontaneous bacterial peritonitis (n = 3); secondary bacteremia (n = 2) and one each with primary bacteremia and colonization of the central catheter tip. Overall, the 30-day mortality rate was 33.3% (5/15) and the outcome depended on the severity of the underlying disorder and infection per se. In conclusion, although our case numbers were limited, due to the substantial incidence and associated mortality of ESBL-producing S. marcescens and its potential treatment failure by an apparently susceptible cephalosporin, we recommend that the detection and report of ESBL production for S. marcescens in clinical laboratories be made mandatory.
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Affiliation(s)
- Kuo-Chen Cheng
- Department of Intensive Care Medicine, Chi-Mei Medical Center, Yongkang, Tainan, Taiwan
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David MD, Weller TMA, Lambert P, Fraise AP. An outbreak of Serratia marcescens on the neonatal unit: a tale of two clones. J Hosp Infect 2006; 63:27-33. [PMID: 16516339 DOI: 10.1016/j.jhin.2005.11.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Accepted: 11/03/2005] [Indexed: 11/28/2022]
Abstract
Serratia spp. are an important cause of hospital-acquired infections and outbreaks in high-risk settings. Twenty-one patients were infected or colonized over a nine-month period during 2001-2002 on a neonatal unit. Twenty-two isolates collected were examined for antibiotic susceptibility, beta-lactamase production and genotype. Random-amplified polymorphic DNA polymerase chain reaction and pulsed-field gel electrophoresis revealed that two clones were present. The first clone caused invasive clinical infection in four babies, and was subsequently replaced by a non-invasive clone that affected 14 babies. Phenotypically, the two strains also differed in their prodigiosin production; the first strain was non-pigmented whereas the second strain displayed pink-red pigmentation. Clinical features suggested a difference in their pathogenicity. No environmental source was found. The outbreak terminated following enhanced compliance with infection control measures and a change of antibiotic policy. Although S. marcescens continued to be isolated occasionally for another five months of follow-up, these were sporadic isolates with distinct molecular typing patterns.
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Affiliation(s)
- M D David
- Microbiology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, UK.
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40
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Giles M, Harwood HM, Gosling DA, Hennessy D, Pearce CT, Daley AJ. What is the best screening method to detect Serratia marcescens colonization during an outbreak in a neonatal intensive care nursery? J Hosp Infect 2006; 62:349-52. [PMID: 16337029 DOI: 10.1016/j.jhin.2005.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 09/14/2005] [Indexed: 11/22/2022]
Abstract
Serratia marcescens can cause outbreaks in neonatal intensive care units (NICUs), but the optimum method of screening for carriage has not been determined in this group of patients. During an outbreak of S. marcescens infections across two geographically distinct NICUs, babies were screened for both respiratory and gastrointestinal carriage. A total of 58 babies were colonized (N = 47) or infected (N = 11) with S. marcescens over a nine-month period. Forty-four colonized babies had paired respiratory and gastrointestinal tract specimens collected. Of these, 39% were positive from the gastrointestinal tract and 22% from respiratory tract specimens alone, and 39% had growth from both sites. Enrichment prior to inoculation on to solid media increased the detection of respiratory tract carriers. During an outbreak of S. marcescens, both respiratory and gastrointestinal samples should be collected in order to maximize the identification of colonized infants. Broth enrichment adds an additional day to obtaining results but increases the yield of positive results from respiratory specimens.
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Affiliation(s)
- M Giles
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia
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Pan A, Dolcetti L, Barosi C, Catenazzi P, Ceruti T, Ferrari L, Magri S, Quiros Roldan E, Soavi L, Carnevale G. An outbreak of Serratia marcescens bloodstream infections associated with misuse of drug vials in a surgical ward. Infect Control Hosp Epidemiol 2006; 27:79-82. [PMID: 16418994 DOI: 10.1086/500250] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Accepted: 09/08/2005] [Indexed: 12/17/2022]
Abstract
We report an outbreak of Serratia marcescens bloodstream infection due to contamination of total parenteral nutrition solution by insulin or poligeline solution when single-use vials were used for multiple doses in a surgical ward. Four patients had severe sepsis, and no patient died. Multidose vials, used either correctly or incorrectly, may be associated with bloodstream infection.
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Affiliation(s)
- Angelo Pan
- Divisione di Malattie Infettive, Spedali Civili- Universita degli Studi di Brescia, Italy.
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Mendoza-Guevara L, Castro-Vazquez F, Aguilar-Kitsu A, Morales-Nava A, Rodriguez-Leyva F, Sanchez-Barbosa JL. Amuchina 10% solution, safe antiseptic for preventing infections of exit-site of Tenckhoff catheters, in the pediatric population of a dialysis program. Contrib Nephrol 2006; 154:139-144. [PMID: 17099309 DOI: 10.1159/000096959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Although, decreasing in incidence with the disconnection systems, the first complication is still peritonitis in patients with chronic renal failure and the second is infection of Tenckhoff catheter exit-site. All efforts made to diminish the frequency of exit-site infection lower the possibility of peritonitis. The pediatric population is well-known to have a major risk of infectious complications, and making easy and safe the care of the exit-site will prevent the peritonitis that follows. The aim of the study was to evaluate the efficacy of the Amuchina 10% solution vs. pH neutral soap in children with chronic renal failure, on preventing exit-site infection. There were 60 patients who were assigned randomly to one of two groups. One group used Amuchina 10% solution for the daily cleaning of the exit-site, and the other used pH neutral soap, with 14 months of follow-up. Before the study they have to be free of infection for at least 30 days. All were taught by the same nurse how to clean their exit-site. Groups were almost identical in years, sex, and time on dialysis. We had nine infections in the soap group and none in the Amuchina 10% solution group, with an OR: 17 (p = 0.004). From these nine infections, the bacteria isolated were: 4 (13%) were caused by Pseudomona aeruginosa, 1 (3.3%) by Staphylococcus aureus, coagulase-positive staphylococci in 2 (6.6%) and Serratia marcensens in 1 (3.3%). In conclusion, Amuchina 10% solution is effective in preventing infection on the exit-site, without any secondary topical reaction.
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Affiliation(s)
- L Mendoza-Guevara
- Hospital de Pediatria, Centro Medico Nacional 'Siglo XXI', Instituto Mexicano del Seguro Social, Mexico, D.F., Mexico
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Yoon HJ, Choi JY, Park YS, Kim CO, Kim JM, Yong DE, Lee KW, Song YG. Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: a clinical, epidemiologic, and laboratory perspective. Am J Infect Control 2005; 33:595-601. [PMID: 16330308 DOI: 10.1016/j.ajic.2005.01.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 01/25/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Serratia marcescens is an aerobic gram-negative bacillus belonging to the family Enterobacteriacea. Infections caused by S marcescens may be difficult to treat because of their resistance to a variety of antibiotics, including beta-lactams and aminoglycosides. METHODS This study aimed to (1) identify the risk factors associated with the development of Serratia marcescens bacteriuria in neurosurgical intensive care units (NSICU); (2) genotype the pathogens to determine the source of infection; (3) compare these results with antibiograms; and (4) determine and implement appropriate control measures. A retrospective case-control study of the epidemiologic data, the surveillance of environmental cultures, and the genotyping of strains using arbitrarily primed polymerase chain reaction (AP-PCR) were performed at a 750-bed, tertiary care teaching hospital. Seventy-four bacteriuria patients were compared with 74 age/sex-matched control patients in the NSICU between March 2002 and March 2004. The factors assessed were patient demographics; duration of hospital stay; duration of indwelling catheter use before and during stay in the NSICU; chronic underlying illnesses (diabetes mellitus, cardiovascular disease, malignancy); other sites of infection; history of trauma; exposure to a nasogastric tube; mechanical ventilation; urinary catheterization; central venous catheterization; surgical drainage; tracheostomy; brain or spine surgery; and receipt of total parenteral nutrition (TPN), antimicrobials (beta-lactams, aminoglycosides, quinolones, carbapenems, vancomycins), or steroids. RESULTS Patients with S marcescens bacteriuria were more likely to have a longer NSICU stay and other sites of infection. Environmental surveillance showed the handling of urine jugs to be the point source of contamination. Genotyping and antibiograms of 14 patients were the same except for those of 2 patients. CONCLUSION The patient-related risk factors were identified, and a rapid identification of the organism was made. Heightened surveillance, infection control measures, and empiric therapy led to improved methods for handling urine jugs, which terminated the outbreak.
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Affiliation(s)
- Hee Jung Yoon
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Dhiraputra C, Tribuddharat C, Pongpech P, Chokephaibulkit K, Danchaivijitr S. Endemic Serratia marcescens in a neonatal intensive care unit. J Med Assoc Thai 2005; 88 Suppl 10:S10-3. [PMID: 16850634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To study the endemicity of Serratia marcescens in a neonatal intensive care unit (N.I.C.U). MATERIAL AND METHOD During the first 4 months of 2001, neonates in the N.I.C.U. in a teaching hospital were screened for S. marcescens by serial throat swabs and collections of other appropriate clinical specimens. Environmental cultures were also done in the same period. Isolated S. marcescens were tested for antimicrobial susceptibility and for genotyping by pulsed field gel electrophoresis. RESULTS During the period, 104 neonates were studied. S. marcescens were isolated in 34.6% of the cases. Environmental cultures were positive for S. marcescens in 1.4%. There were 10 patterns of antibiogram of the 190 strains isolated. All strains belonged to pulsotype A. CONCLUSION The study confirmed that S. marcescens was endemic in the N.I.C.U. and belonged to one genotype.
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Affiliation(s)
- Chertsak Dhiraputra
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
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Casolari C, Pecorari M, Fabio G, Cattani S, Venturelli C, Piccinini L, Tamassia MG, Gennari W, Sabbatini AMT, Leporati G, Marchegiano P, Rumpianesi F, Ferrari F. A simultaneous outbreak of Serratia marcescens and Klebsiella pneumoniae in a neonatal intensive care unit. J Hosp Infect 2005; 61:312-20. [PMID: 16198443 DOI: 10.1016/j.jhin.2005.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Accepted: 03/13/2005] [Indexed: 12/19/2022]
Abstract
We describe two concurrent outbreaks of Serratia marcescens and Klebsiella pneumoniae in a neonatal intensive care unit (NICU). Over a 16-month period, a total of 27 infants were either colonized (N=14) or infected (N=13). There were 15 cases of S. marcescens and 11 cases of K. pneumoniae. Both micro-organisms were involved in one fatal case. Seven preterm babies developed septicaemia, two had bacteraemia, three had respiratory infections and one had purulent conjunctivitis. The S. marcescens and K. pneumoniae isolates were investigated by three molecular methods: enterobacterial repetitive intergenic consensus polymerase chain reaction (PCR), arbitrary primed PCR with M13 primer, and random amplification of polymorphic DNA. Different patterns were found in the 16 S. marcescens epidemic isolates from 16 newborn infants. The major epidemic-involved genotype was linked to the first nine cases and this was subsequently replaced by different patterns. Eight different typing profiles were also determined for the 13 K. pneumoniae isolates from 12 newborn infants. Four K. pneumoniae bacteraemic strains proved to be identical. In conclusion, the typing results revealed that two different micro-organisms (S. marcescens and K. pneumoniae) were simultaneously involved in invasive nosocomial infections in preterm newborns. Two simultaneous clusters of cases were documented. Heterogeneous genotypes among both species were also demonstrated to be present in the NICU at the same time. A focal source for both micro-organisms was not identified but cross-transmission through handling was probably an important route in this outbreak. Strict adherence to handwashing policies, cohorting, isolation of colonized and infected patients, and rigorous environmental hygiene were crucial measures in the containment of the epidemic.
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Affiliation(s)
- C Casolari
- Unit of Microbiology and Virology, Policlinico of Modena, Italy
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Bates CJ, Pearse R. Use of hydrogen peroxide vapour for environmental control during a Serratia outbreak in a neonatal intensive care unit. J Hosp Infect 2005; 61:364-6. [PMID: 16099537 DOI: 10.1016/j.jhin.2005.05.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Accepted: 05/17/2005] [Indexed: 11/23/2022]
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Dubouix A, Roques C, Segonds C, Jeannot MJ, Malavaud S, Daude S, Chabanon G, Marty N. Epidemiological investigation of a Serratia liquefaciens outbreak in a neurosurgery department. J Hosp Infect 2005; 60:8-13. [PMID: 15823650 DOI: 10.1016/j.jhin.2004.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2003] [Accepted: 09/10/2004] [Indexed: 11/16/2022]
Abstract
Between February 2001 and March 2003, 17 patients from the neurosurgery department of the University Hospital of Rangueil (Toulouse, Southern France) developed Serratia liquefaciens infections. Due to the atypical antibiotype displayed by the clinical isolates (i.e. gentamicin resistance), an outbreak was suspected. Molecular analysis carried out by pulsed-field gel electrophoresis demonstrated a genetic link for all patients. Furthermore, the patient who introduced the epidemic Serratia strain was also identified and shown to be related to the two epidemic peaks observed during the outbreak period. Investigation failed to reveal a reservoir among the antiseptics and soaps, or among the mechanical ventilators used. However, when the colonization of patients was investigated, positive carriage was observed and could be considered as a potential risk for the spread of the epidemic strain. Due to the delay between antibiotherapy and S. liquefaciens colonization, a selection effect had to be considered. Finally, implementation of hygiene measures was accompanied by control of the outbreak.
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Affiliation(s)
- A Dubouix
- Laboratoire de Bactériologie-Hygiène, CHU Rangueil-Larrey, Toulouse, France.
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Cullen MM, Trail A, Robinson M, Keaney M, Chadwick PR. Serratia marcescens outbreak in a neonatal intensive care unit prompting review of decontamination of laryngoscopes. J Hosp Infect 2005; 59:68-70. [PMID: 15571857 DOI: 10.1016/j.jhin.2004.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Accepted: 08/05/2004] [Indexed: 12/21/2022]
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Sarvikivi E, Lyytikäinen O, Salmenlinna S, Vuopio-Varkila J, Luukkainen P, Tarkka E, Saxén H. Clustering of Serratia marcescens infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004; 25:723-9. [PMID: 15484795 DOI: 10.1086/502467] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To study clusters of infections caused by Serratia marcescens in a neonatal intensive care unit (NICU) and to determine risk factors for S. marcescens infection or colonization. DESIGN Genotyping of S. marcescens isolates was performed by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted. SETTING A tertiary-care pediatric hospital with a 16-bed NICU. PATIENTS All neonates with at least one culture positive for S. marcescens in the NICU during December 1999 to July 2002. Case-patients (n = 11) treated in the NICU during December 1999 to February 2000 were included in the case-control study. Neonates treated in the NICU for at least 72 hours during the same period with cultures negative for S. marcescens were used as control-patients (n = 27). RESULTS S. marcescens was cultured from 19 neonates; 9 were infected and 10 were colonized. PFGE analysis identified three epidemic strains; each cluster consisted of identical isolates, except one isolate in the first cluster that was different. The risk factors identified were low birth weight, prematurity, prolonged respiratory therapy, prolonged use of antibiotics, and maternal infection prior to delivery. Overcrowding and understaffing were recorded simultaneously with the clusters. CONCLUSIONS PFGE analysis showed three independent clusters. Several factors contributed to spread of the epidemic strains: (1) there were many severely premature and susceptible neonates, (2) the NICU was overcrowded during the clusters, and (3) transmission was likely to occur via the hands of staff. Cohorting and improvement of routine infection control measures led to the cessation of each cluster.
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Affiliation(s)
- Emmi Sarvikivi
- Hospital for Children and Adolescents, Helsinki, Finland
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Milisavljevic V, Wu F, Larson E, Rubenstein D, Ross B, Drusin LM, Della-Latta P, Saiman L. Molecular epidemiology of Serratia marcescens outbreaks in two neonatal intensive care units. Infect Control Hosp Epidemiol 2004; 25:719-21. [PMID: 15484794 DOI: 10.1086/502466] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Serratia marcescens can cause serious infections in patients in neonatal intensive care units (NICUs), including sepsis, pneumonia, urinary tract infection, and conjunctivitis. We report the utility of genetic fingerprinting to identify, investigate, and control two distinct outbreaks of S. marcescens. DESIGN An epidemiologic investigation was performed to control two clusters of S. marcescens infections and to determine possible routes of transmission. Molecular typing by pulsed-field gel electrophoresis determined the relatedness of S. marcescens strains recovered from neonates, the environment, and the hands of healthcare workers (HCWs). SETTING Two geographically distinct level III-IV NICUs (NICU A and NICU B) in two university-affiliated teaching hospitals in New York City. RESULTS In NICU A, one major clone, "F," was detected among isolates recovered from four neonates and the hands of one HCW. A second predominant clone, "A," was recovered from four sink drains and one rectal surveillance culture from an asymptomatic neonate. In NICU B, four neonates were infected with clone "D," and three sink drains harbored clone "H." The attributable mortality rate from bloodstream infections was 60% (3 of 5 infants). The antimicrobial susceptibilities of clone F strains varied for amikacin, cefepime, and piperacillin/tazobactam. CONCLUSIONS S. marcescens causes significant morbidity and mortality in preterm neonates. Cross-transmission via transient hand carriage of a HCW appeared to be the probable route of transmission in NICU A. Sinks did not harbor the outbreak strains. Antimicrobial susceptibility patterns did not prove to be an accurate predictor of strain relatedness for S. marcescens.
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Affiliation(s)
- Vladana Milisavljevic
- Department of Pediatrics, School of Nursing, Columbia University, New York, New York, USA
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