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Epidemiological and bacteriological investigation of Serratia marcescens epidemic in a nursery and in a neonatal intensive care unit

Published online by Cambridge University Press:  19 October 2009

D. Montanaro ,
G. M. Grasso ,
I. Annino ,
N. de Ruggiero ,
A. Scarcella  and
F. Schioppa
D. Montanaro
Affiliation:
Institute of Hygiene and Università di Napoli, Via S. Pansini 5, 80131 Napoli, Italy
G. M. Grasso
Affiliation:
Institute of Hygiene and Università di Napoli, Via S. Pansini 5, 80131 Napoli, Italy
I. Annino
Affiliation:
Institute of Hygiene and Università di Napoli, Via S. Pansini 5, 80131 Napoli, Italy
N. de Ruggiero
Affiliation:
Institute of Hygiene and Università di Napoli, Via S. Pansini 5, 80131 Napoli, Italy
A. Scarcella
Affiliation:
Department of Paediatrics II Facoltà di Medicina, Università di Napoli, Via S. Pansini 5, 80131 Napoli, Italy
F. Schioppa
Affiliation:
Institute of Hygiene and Università di Napoli, Via S. Pansini 5, 80131 Napoli, Italy
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Summary

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An epidemic caused by Serratia marcescens that involved 26 infants admitted to the Neonatal Intensive Care Unit (NICU) and 82 infants admitted to the Nursery of the 2nd Medical School of Naples is reported. Two different biotypes of S. marcescens with two completely different epidemiological patterns were identified. The prevalent biotype (A8b trigonelline –) was isolated in the delivery room, in the operating room, in the Nursery and in the NICU from items, healthy infant excreters and affected infants; the second biotype (A3a) was isolated only in the NICU from staff, two healthy infant excreters and two affected infants. Colonization of the throat and the gastrointestinal tract was frequent. Infected and colonized infants were the most important reservoir for serratia in the Nursery and in the NICU particularly for the type strain A3a. A mucus aspiration apparatus contaminated in the delivery room and the contamination of several instruments and items probably had a major role in the initiation and maintenance of the spread of the A8b strain. Mass contamination of the nursery has been related to overcrowding and a lack of the control measures; the transfer of high-risk colonized infants caused spread in the NICU.

In the NICU the attack rate was 26%; 69% of infants became ill; the case fatality ratio was 19%. Epidemiological investigation of the infants at risk showed some factors predisposing to infection with serratia. The hygienic measures failed to control the spread of serratia and it was necessary to refuse new admissions to pregnant women in order to decontaminate and re-organize the wards.

Type
Research Article
Information
Journal of Hygiene , Volume 93 , Issue 1 , August 1984 , pp. 67 - 78
Copyright
Copyright © Cambridge University Press 1984

References

REFERENCES

Allen, S. D. & Conger, K. B. (1969). Serratia marcescens infection of the urinary tract: a nosocomial infection. Journal of Urology 101, 621–623.CrossRefGoogle ScholarPubMed
Anagnostakis, D., Fitsialos, J., Koutsia, C., Messaritakis, J. & Matsaniotis, N. (1981). A nursery outbreak of Serratia marcescens infection: evidence of a single source of contamination. American Journal of Diseases of Children 135, 413—414.CrossRefGoogle ScholarPubMed
Bauer, A. W., Kirby, W. M. M., Sherris, J. C. & Turck, M. (1966). Antibiotic susceptibility testing by a standardized single disc method. American Journal of Clinical Pathology 45, 493–496.CrossRefGoogle Scholar
Branca, G., Manzaka, S., Scanu, L. & Chezzi, C. (1979). La produzione di batteriocine come marker epidemiologico di Serratia marcescens. Igiene Moderna 72, 467–473.Google Scholar
Cabrera, M. A. (1969). An outbreak of Serratia marcescens and its control. Archives of Internal Medicine 123, 650–655.CrossRefGoogle ScholarPubMed
Clayton, E. & Von Graevenitz, A. (1966). Non pigmented Serratia marcescens. Journal of American Medical Associatión 197, 1059–1064.CrossRefGoogle Scholar
Cleary, T. J., Macintyre, D. S. & Castro, M. (1981). Serratia marcescens bacteremias in an intensive care unit. Contaminated heparinized saline solution as a reservoir. American Journal of Infection Control 9/4, 107–111.CrossRefGoogle Scholar
Edwards, P. R. & Ewing, W. H. (1972). The genus Serratia. In Identification of Enterobacteriaceae, pp. 308–317. Minneapolis: Burgess (1979).Google Scholar
Ewing, W. H., Johnson, J. G. & Davis, B. R. (1962). The occurrence of Serralia marcescens in nosocomial infections. U.S. Department of Health, Education and Welfare, Washington, D.C.Google Scholar
Farmer, J. J. III (1972). Epidemiological differentiations of Serratia marcescens: typing by bacteriocin sensitivity. Applied Microbiology 23, 226–231.Google Scholar
Grimont, P. A. D. & Grimont, F. (1978). Biotyping of Serratia marcescens and its use in epidemiological studies. Journal of Clinical Microbiology 8, 73–83.CrossRefGoogle ScholarPubMed
Haley, R. W. & Bregman, D. A. (1982). The role of understaffingand overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. Journal of Infectious Diseases 145, 875–885.CrossRefGoogle Scholar
Jones, S. R., Amon, M., Falvey, C. & Patrick, K. (1978). Serratia marcescens colonising the gut. Lancet 20, 1105.Google Scholar
Krieger, J. N., Leuy-Zombek, E., Scheidt, A. & Drusin, L. M. (1980). A nosocomial epidemic of antibiotic-resistant Serratia marcescens urinary tract infections. Journal of Urology 124/4, 498–502.Google Scholar
Lancaster, L. J. (1962). Role of Serratia species in urinary tract infections. Archives of Internal Medicine 109, 536–539.CrossRefGoogle ScholarPubMed
Mc Cormack, R. C. & Kunin, C. M. (1966). Control of a single source nursery epidemic due to Serratia marcescens. Journal of Pediatrics 37, 750–755.Google Scholar
Mc Cracken, A. W. & Lipscomb, F. E. (1965). Serratia marcescens infection complicating peritoneal dialysis. British Medical Journal i, 1536–1537.CrossRefGoogle Scholar
Meers, P. D., Foster, C. S. & Churcher, G. M. (1978). Cross-infection with Serratia marcescens. British Medical Journal 28, 238–239.Google Scholar
Mutton, K. J., Brady, L. M. & Markness, J. L. (1981). Serratia cross-infection in an intensive therapy unit. Journal of Hospital Infection 2, 85–92.Google Scholar
Rabinowitz, K. & Schiffrin, R. (1953). Ward contamination with Serratia marcescens. Acta Medica Orientalis 11, 181–184.Google Scholar
Rutala, W. A., Kennedy, V. A., Coflin, H. B. & Sarubbi, F. A. Jr (1981). Serratia marcescens nosocomial infections of the urinary tract associated with urine measuring containers and urinometers. American Journal of Medicine 70, 659–663.Google Scholar
Sanders, C. V. Jr, Luby, J. P., Johanson, W. G., Barnett, A. & Sanders, J. P. (1970). Serratia marcescens infection from inhalation therapy. Annals of Internal Medicine 73, 15–21.Google Scholar
Schaberg, D. R., Alford, R. M., Anderson, R., Farmer, J. J. III. Melly, M. A. & Schaffner, W. (1976). An outbreak of nosocomial infection due to multiply resistant Serratia marcescens: evidence of interhospital spread. Journal of Infectious Diseases 134, 181–188.Google Scholar
Sonnenwirth, A. C. (1980). Bacteriology. In Oradwohl's Clinical Laboratory Methods and Diagnosis (ed. Sonnenwirth, A. C. and Jarrett, L.), chapters 70, 72, 75, 77, 79. St Louis: C. V. Mosby.Google Scholar
Stamm, W. E., Kolff, C. A., Munoz O'ones, E., Javariz, R., Anderson, R. L., Farmer, J. J. III & Rivera De Quinones, M. (1976). A nursery outbreak caused by Serratia marcescens scalp-vein needles as a portal of entry. Journal of Pediatrics 83, 96–99.CrossRefGoogle Scholar
Stenderup, A., Faergeman, D. & Ingerslev, M. (1966). Serratia marcescens infections in premature infants. Acta Pathologica Microbiologica Scandinavica 68, 157–160.CrossRefGoogle ScholarPubMed
Taylor, G. & Keane, P. M. (1962). Cross-infection with Serratia marcescens. Journal of Clinical Pathology 15, 145–147.CrossRefGoogle ScholarPubMed
Traub, W. H., Raymond, E. A. & Startsman, T. S. (1971). Bacteriocin (marcescin) typing of clinical isolates of Serratia marcescens. Applied Microbiology 21, 837–840.Google Scholar