Skip to main content Accessibility help
×
Home
Hostname: page-component-747cfc64b6-zmlw7 Total loading time: 0.191 Render date: 2021-06-16T11:37:11.728Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

Nosocomial Serratia marcescens Outbreak in Osaka, Japan, From 1999 to 2000

Published online by Cambridge University Press:  02 January 2015

Hiroshi Takahashi
Affiliation:
Field Epidemiology Training Program Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
Michael H. Kramer
Affiliation:
Field Epidemiology Training Program
Yoshinori Yasui
Affiliation:
Sakai City Health Center, Sakai, Osaka, Japan
Hayato Fujii
Affiliation:
Field Epidemiology Training Program
Katsumi Nakase
Affiliation:
Field Epidemiology Training Program
Kazunori Ikeda
Affiliation:
Sakai City Health Center, Sakai, Osaka, Japan
Tatsuya Imai
Affiliation:
Sakai City Health Center, Sakai, Osaka, Japan
Akiko Okazawa
Affiliation:
Sakai City Health Center, Sakai, Osaka, Japan
Tomoyuki Tanaka
Affiliation:
Sakai City Institute of Public Health, Sakai, Osaka, Japan
Takaaki Ohyama
Affiliation:
Field Epidemiology Training Program Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
Nobuhiko Okabe
Affiliation:
Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan

Abstract

Objectives:

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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below.

References

1.Wheat, RP, Zuckerman, A, Rantz, LA. Infection due to chromobacteria: report of eleven cases. Arch Intern Med 1951;88:461466.CrossRefGoogle Scholar
2.Cabrera, HA. An outbreak of Serratia marcescens and its control. Arch Intern Med 1969;123:650655.CrossRefGoogle ScholarPubMed
3.Maki, DG, Martin, WT. Nationwide epidemie of septicemia caused by contaminated infusion products: IV. Growth of microbial pathogens in fluids for intravenous infusion. J Infect Dis 1975;131:267272.CrossRefGoogle Scholar
4.Bjornson, HS, Colley, R, Bower, RH, Duty, VP, Schwartz-Fulton, JT, Fischer, JE. Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. Surgery 1982;92:720727.Google ScholarPubMed
5.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.CrossRefGoogle ScholarPubMed
6.Sartor, C, Jacomo, V, Duvivier, C, Tissot-Dupont, H, Sambuc, R, Drancourt, M. Nosocomial Serratia marcescens infections associated with extrinsic contamination of liquid nonmedicated soap. Infect Control Hosp Epidemiol 2000;21:196199.CrossRefGoogle ScholarPubMed
7.Bosi, C, Davin-Regli, A, Charrel, R, Rocca, B, Monnet, D, Bollet, C. Serratia marcescens nosocomial outbreak due to contamination of hexetidine solution. J Hosp Infect 1996;33:217224.CrossRefGoogle ScholarPubMed
8.Vigeant, P, Loo, V, Bertrand, C, et al.An outbreak of Serratia marcescens infections related to contaminated chlorhexidine. Infect Control Hosp Epidemiol 1999;19:791794.CrossRefGoogle Scholar
9.Yu, VL. Serratia marcescens: historical perspective and clinical review. N Engl J Med 1979;300:887893.CrossRefGoogle ScholarPubMed
10.Sokalski, SJ, Jewell, MA, Asmus-Shillington, AC, Mucahy, J, Segreti, J. An outbreak of Serratia marcescens in 14 adult cardiac surgical patients associated with 12-lead electrocardiogram bulbs. Arch Intern Med 1992;152:841844.CrossRefGoogle ScholarPubMed
11.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.CrossRefGoogle ScholarPubMed
12.Sanders, CV, Luby, JP, Johanson, WG, Barnett, JA, Sanford, JP. Serratia marcescens infections from inhalation therapy medications: nosocomial outbreak. Ann Intern Med 1970;73:1521.CrossRefGoogle ScholarPubMed
13.Ringrose, RE, McKown, B, Felton, FG, Barclay, BO, Muchmore, HG, Rhodes, R. A hospital outbreak of Serratia marcescens associated with ultrasonic nebulizers. Ann Intern Med 1968;69:719729.CrossRefGoogle ScholarPubMed
14.Rhoades, ER, Ringrose, R, Mohr, JA, Brooks, L, McKown, BA, Felton, F. Contamination of ultrasonic nebulization equipment with gram negative bacteria. Arch Intern Med 1971;127:228232.CrossRefGoogle ScholarPubMed
15.Whitby, JL, Blair, JN, Rampling, A. Cross-infection with Serratia marcescens in an intensive-therapy unit. Lancet 1972;15:127129.CrossRefGoogle Scholar
16.Johanson, WG Jr. Pneumonia caused by aerobic gram-negative bacilli. In: Goldman, L, Bennett, JC, eds. Cecil Textbook of Medicine, ed. 21. Philadelphia: W. B. Saunders; 2000:16121615.Google Scholar
17.Ministry of Health and Welfare, Japan. A Report for Development of Drug Resistant Infections Disease Surveillance, April, 2000. Japan: Ministry of Health and Welfare; 2000.Google Scholar
18.Centers for Disease Control and Prevention. National Nosocomial Infection Surveillance (NNIS) report: data summary from October 1986-April 1996. Am J Infect Control 1996;24:380388.CrossRefGoogle ScholarPubMed
19.Grohskopf, LA, Roth, VR, Feikin, DR, et al.Serratia liquefaciens blood-stream infections from contamination of epoetin alfa at a hemodialysis center. N Engl J Med 2001;344:14911497.CrossRefGoogle Scholar
20.Morikane, T, Nishioka, M, Konishi, T, et al.Initiation of nation-wide infection surveillance in Japan. Presented at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections; March 5-9, 2000; Atlanta, GA.Google Scholar
21.Zen-Nihon Min-Iren, Medical Service Department. Infection Control Initiated by AU: Zen-Nihon Min-Iren Infection Control Guidelines 2001 [in Japanese]. Tokyo: Hoken Iryo Laboratory; 2001.Google Scholar
19
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Nosocomial Serratia marcescens Outbreak in Osaka, Japan, From 1999 to 2000
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Nosocomial Serratia marcescens Outbreak in Osaka, Japan, From 1999 to 2000
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Nosocomial Serratia marcescens Outbreak in Osaka, Japan, From 1999 to 2000
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *