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Epidemic Serratia marcescens in a Neonatal Intensive Care Unit: Importance of the Gastrointestinal Tract as a Reservoir

  • Gordon D. Christensen (a1) (a2), Sheldon B. Korones (a3) (a4), Louise Reed (a2), Roderick Bulley (a5), B. McLaughlin (a2) and Alan L. Bisno (a2)...


Between March and December of 1979, an outbreak of infections due to multiply antibiotic resistant Serratia marcescens took place in a 50-bed neonatal intensive care unit. Fifteen neonates suffered major infections (sepsis, meningitis and pneumonia) with one death, and 20 suffered minor infections (conjunctivitis, cystitis, wound infections). Epidemiologic investigation failed to reveal a common source; S. marcescens, however, was isolated from an employee's hand, emollient skin cleanser, suction tubing, and three in-use manual infant resuscitation bags. The skin cleanser and equipment-cleaning agents were ineffective against S. marcescens. Asymptomatic, colonized infants were the major reservoir of S. marcescens. These infants were identified by daily cultures of the nose, umbilicus and rectum. The rectal swab most commonly (76%) yielded first-positive cultures in previously uncolonized infants, and was ultimately positive in 92% of colonized infants. A control program was begun by: 1) removing all inanimate sources of S. marcescens; and 2) cohorting patients and staff into a S. marcescens-exposed group and a new patient group. The new patient group of infants was surveyed by daily triple-site cultures for colonization and subsequent transfer to the S. marcescens-exposed group. After four months, the epidemic was controlled and the organism eradicated from the neonatal intensive care unit.


Corresponding author

Office of Infection Control, City of Memphis Hospital, 860 Madison Avenue, Memphis, Tennessee 38163


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1. Yu, VL. Serratia marcescens, historical perspective and clinical review. N Engl J Med 1979; 300:887893.
2. Farmer, JJ, et al. Detection of Serratia outbreaks in hospital. Lancet 1976; 2:455459.
3. Meyer, RD, et al. Gentamicin-resistant Pseudomonas aeruginosa and Serratia marcescens in a general hospital. Lancet 1976; 1:580583.
4. Yu, VL, et al. Patient factors contributing to the emergence of gentamicin-resistant Serratia marcescens . Am J Med 1979; 66:468472.
5. Maki, GD, et al. Nosocomial urinary tract infection with Serratia marcescens: An epidemiologic study. J Infect Dis 1973; 128:579587.
6. Schaberg, DR, et al. An outbreak of nosocomial infection due to multiply resistant Serratia marcescens: Evidence of interhospital spread. J Infect Dis 1976; 134:181188.
7. Centers for Disease Control. Outline for Surveillance and Control of Nosocomial Infections. Appendix II: Guidelines for determining presence and classification of infection. Atlanta: CDC, DHEW, 1972 (Reprinted Sept 1973, May 1974, Nov 1976).
8. Korones, SB and Lancaster, J. Disturbance in infants rest. In: Iatrogenic Problems in Neonatal Intensive Care. Report of the 69th Ross Conference on Pediatric Research, Ross Laboratories, Columbus, Ohio, 1976, pp. 9497.
9. Bauer, AW, et al. Antibiotic susceptibility testing by a standardized single disc method. Am J Clin Pathol 1966; 45:493496.
10. Association of Official Analytic Chemists. Official Methods of Analysis. Vol. 11, Washington, DC: A.O.A.C., 1970, pp. 5961.
11. Layne, JS and Bulley, R. Unpublished.
12. Wilkowske, CJ, et al. Serratia marcescens: Biochemical characteristics, antibiotic susceptibility patterns, and clinical significance. JAMA 1970; 214:21572162.
13. Stenderup, A, Faergeman, O, Ingerslev, M. Serratia marcescens infections in premature infants. Acta Pathol Microbiol Scand 1966; 68:157160.
14. Hemming, VG, Overall, JC, Britt, MR. Nosocomial infections in a newborn intensive care unit: Results of forty-one months of surveillance. N Engl J Med 1976; 294:13101316.
15. Baker, CJ. Nosocomial septicemia and meningitis in neonates. Am J Med 1981; 70:698701.
16. Goldmann, DA. Bacterial colonization and infections in neonate. Am J Med 1981; 70:417422.
17. Cabrera, HA. An outbreak of Serratia marcescens and its control. Arch Intern Med 1969; 123:650655.
18. Whitby, JL, Blair, JN, Rampling, A. Cross-infection with Serratia marcescens in an intensive therapy unit. Lancet 1972; 2:127128.
19. Richards, NM and Levitsky, S. Outbreak of Serratia marcescens infections in a cardiothoracic surgical intensive care unit. Ann Thorac Surg 1975; 19:503513.
20. Ehrenkranz, NJ, Bolyard, EA, Wiener, M. Antibiotic sensitive Serratia marcescens infections complicating cardiopulmonary operations: Contaminated disinfectant as a reservoir. Lancet 1980; 2:12891291.
21. Morse, JL and Schonbeck, LE. Hand lotions—A potential nosocomial hazard. N Engl J Med 1968; 278:376378.
22. Stamm, WE, et al. A nursery outbreak caused by Serratia marcescens: Scalp-vein needles as a portal of entry. J Pediatr 1976; 89:9699.
23. Knittle, MA, Eitzman, DV, Baer, H. Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections. J Pediatr 1975; 86:433437.
24. Eisenach, KD, et al. Nosocomial infections due to kanamycin-resistant (R) factors carrying enteric organisms in an intensive care nursery. Pediatr 1972; 50:395402.
25. Cook, LN, Davis, RS, Stover, BH. Outbreak of amikacin-resistant Enterobacteriaceae in an intensive care nursery. Pediat 1980; 65:264268.
26. Goldmann, DA, Leclair, J, Macone, A. Bacterial colonization of neonates admitted to an intensive care environment. J Pedatr 1978; 93:288293.
27. Mayhall, GC, et al. Nosocomial Klebsiella infection in a neonatal unit: Indentification of risk factors for gastrointestinal colonization. Infect Control 1980; 1:239246.
28. Morehead, DC and Houck, PW. Epidemiology of Pseudomonas infections in a pediatric intensive care unit. Amer J Dis Child 1972; 124:564570.
29. Adler, JL, et al. Nosocomial colonization with kanamycin-resistant Klebsiella pneumoniae types 2 and 11 in a premature nursery. J Pediatr 1970; 77:376385.
30. Hable, KA, et al. Klebsiella type 33 septicemia in an infant intensive care unit. J Pediatr 1972; 80:920924.
31. Rose, HD and Babcock, JB. Colonization of intensive care unit patients with gram-negative bacilli. Am J Epidemiol 1975; 101:495501.
32. Noy, JH, Ayliffe, GAJ, Linton, KB. Antibiotic-resistant gram-negative bacilli in the faeces of neonates. J Med Microbiol 1974; 7:509520.
33. Waisman, HA and Stone, WH. The presence of Serratia marcescens as the predominating organism in the intestinal tract of the newborn. Pediatrics 1958; 21:812.
34. McCormark, RC and Kunin, CM. Control of a single source nursery epidemic due to Serratia marcescens . Pediatrics 1966; 37:750755.
35. Parry, MF, et al. Gram-negative sepsis in neonates: A nursery outbreak due to hand carriage of Citrobacter diversus . Pediat 1980; 65:11051109.

Epidemic Serratia marcescens in a Neonatal Intensive Care Unit: Importance of the Gastrointestinal Tract as a Reservoir

  • Gordon D. Christensen (a1) (a2), Sheldon B. Korones (a3) (a4), Louise Reed (a2), Roderick Bulley (a5), B. McLaughlin (a2) and Alan L. Bisno (a2)...


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