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An Outbreak of Serratia marcescens Bacteremia After General Anesthesia

  • Michael E. Sebert (a1), Mary Lou Manning (a2), Karin L. McGowan (a1), Elizabeth R. Alpern (a3) and Louis M. Bell (a1) (a4) (a3) (a2)...

Abstract

Objective:

To investigate an outbreak of Serratia marcescens bacteremia among patients after general anesthesia.

Design:

A case-control study.

Setting:

A 304-bed, pediatric teaching hospital.

Patients:

Twenty-three pediatric patients who developed S. marcescens bacteremia within 2 weeks after general anesthesia between June 15 and September 22, 1999, were compared with 46 age-matched control-patients who had undergone procedures on the same clinical services of the hospital during the same period.

Results:

Cases were distributed over a wide range of surgical services and were not correlated with exposure to any of the surgical, anesthesia, or nursing staff. Case-patients were significantly more likely than control-patients to have received cefazolin (odds ratio [OR], 11.1; 90% confidence interval [CI90], 1.9 to 24.3) or to have had perioperative placement of a central vascular catheter (OR, 4.2; CI90, 1.2 to 18.8). The timing of the procedures of patients who subsequently developed S. marcescens bacteremia was significantly associated with the shifts of one or more of five operating room technicians (OR, 2.9 to 6.8) who were responsible for preparing intravenous fluids used both to reconstitute perioperatively administered antibiotics and to prime central vascular catheter assemblies.

Conclusions:

Our findings are consistent with a pattern of intermittent contamination due to periodic breaches in sterile technique, rather than a point-source of contamination. The unique challenges that such a procedural breakdown presents to an epidemiologic investigation are discussed. This outbreak stresses the importance of providing comprehensive training in antisepsis when multifunctional personnel are incorporated into an operating room work environment.

Copyright

Corresponding author

Department of Pediatrics, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104

References

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1.Yu, VL. Serratia marcescens: historical perspective and clinical review. N Engl J Med 1979;300:887893.
2.Donowitz, LG, Marsik, FJ, Hoyt, JW, Wenzel, RP. Serratia marcescens bacteremia from contaminated pressure transducers. JAMA 1979;242:17491751.
3.Villarino, ME, Jarvis, WR, O'Hara, C, Bresnahan, J, Clark, N. Epidemic of Serratia marcescens bacteremia in a cardiac intensive care unit. J Clin Microbiol 1989;27:24332436.
4.Vandenbroucke-Grauls, CMJE, Baars, ACM, Visser, MR, Hulstaert, PF, Verhoef, J. An outbreak of Serratia marcescens traced to a contaminated bronchoscope. J Hosp Infect 1993;23:263270.
5.Bennett, SN, McNeil, MM, Bland, LA, et al. Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med 1995;333:147154.
6.Archibald, LK, Corl, A, Shah, B, et al. Serratia marcescens outbreak associated with extrinsic contamination of 1% chlorxylenol soap. Infect Control Hosp Epidemiol 1997;18:704709.
7.McAllister, TA, Lucas, CE, Mocan, H, et al. Serratia marcescens outbreak in a paediatric oncology unit traced to contaminated Chlorhexidine. Scott Med J 1989;34:525528.
8.Knowles, S, Herra, C, Devitt, E, et al. An outbreak of multiply resistant Serratia marcescens: the importance of persistent carriage. Bone Marrow Transplant 2000;25:873877.
9.Smith, PJ, Brookfield, DSK, Shaw, DA, Gray, J. An outbreak of Serratia marcescens infection in a neonatal unit. Lancet 1984;1:151153.
10.Campbell, JR, Zaccaria, E, Mason, EO, Baker, CJ. Epidemiological analysis defining concurrent outbreaks of Serratia marcescens and methicillin-resistant Staphylococcus aureus in a neonatal intensive-care unit. Infect Control Hosp Epidemiol 1998;19:924928.
11.Christensen, GD, Korones, SB, Reed, L, Bulley, R, McLaughlin, B, Bisno, AL. Epidemic Serratia marcescens in a neonatal intensive care unit: importance of the gastrointestinal tract as a reservoir. Infect Control 1982;3:127133.
12.Zaidi, M, Sifuentes, J, Bobadilla, M, Moncada, D, Ponce de León, S. Epidemic of Serratia marcescens bacteremia and meningitis in a neonatal unit in Mexico City. Infect Control Hosp Epidemiol 1989;10:1420.
13.Manning, ML, Archibald, LK, Bell, LM, Banerjee, SN, Jarvis, WR. Serratia marcescens transmission in a pediatric intensive care unit: a multifactorial occurrence. Am J Infect Control 2001;29:115119.
14.Hoyen, C, Rice, L, Conte, S, Jacobs, MR, Walsh-Sukys, M, Toltzis, P. Use of real time pulsed field gel electrophoresis to guide interventions during a nursery outbreak of Serratia marcescens infection. Pediatr Infect Dis J 1999;18:357360.
15.Maslow, JN, Slutsky, AM, Arbeit, RD. The application of pulsed field gel electrophoresis to molecular epidemiology. In: Pershing, DH, Smith, TF, Tenover, FC, White, TJ, eds. Diagnostic Molecular Microbiology: Principles and Applications. Washington, DC: ASM Press; 1993:563572.
16.Miettinen, OS. Estimation of relative risk from individually matched series. Biometrics 1970;26:7586.

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