Hostname: page-component-76fb5796d-zzh7m Total loading time: 0 Render date: 2024-04-26T08:59:00.577Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial Outbreak of Serratia Marcescens in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Ojan Assadian ,
Angelika Berger ,
Christoph Aspöck ,
Stefan Mustafa ,
Christina Kohlhauser  and
Alexander M. Hirschl
Ojan Assadian*
Affiliation:
Clinical Institute for Hygiene and Medical Microbiology, University of Vienna Medical School, Division of Hospital Hygiene, Vienna, Austria
Angelika Berger
Affiliation:
Department of Neonatology, Inborn Errors of Metabolism and Pediatric Intensive Care, University Children's Hospital, Vienna, Austria
Christoph Aspöck
Affiliation:
Clinical Institute for Hygiene and Medical Microbiology, University of Vienna Medical School, Division of Hospital Hygiene, Vienna, Austria
Stefan Mustafa
Affiliation:
Clinical Institute for Hygiene and Medical Microbiology, University of Vienna Medical School, Division of Hospital Hygiene, Vienna, Austria
Christina Kohlhauser
Affiliation:
Department of Neonatology, Inborn Errors of Metabolism and Pediatric Intensive Care, University Children's Hospital, Vienna, Austria
Alexander M. Hirschl
Affiliation:
Clinical Institute for Hygiene and Medical Microbiology, University of Vienna Medical School, Division of Clinical Microbiology, Vienna, Austria
*
Clinical Institute for Hygiene and Medical Microbiology, University of Vienna Medical School, Division of Hospital Hygiene, Vienna General Hospital, Waehringer Guertel 18-20, A -1090 Vienna, Austria
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To investigate and describe an outbreak of Serratia marcescens in a neonatal intensive care unit (NICU) and to report the interventions leading to cessation of the outbreak.

Setting:

A 2,168-bed, tertiary-care, university teaching hospital in Vienna, Austria, with an 8-bed NICU.

Design:

We conducted a case–control study to identify risk factors for colonization and infection with S. marcescens. A case-patient was defined as any neonate in the NICU with a positive culture for S. marcescens between October 1, 2000, and February 28, 2001. Polymerase chain reaction was applied to type isolates.

Methods:

During unannounced observations, the NICU was examined and existing policies were reviewed. Staff were reinstructed in hand antisepsis and gloving policies. Admissions were halted on December 27. During previously planned technical maintenance of the ward, the NICU was closed for 10 days and thorough aldehyde-based disinfection of the NICU was performed.

Results:

Ten neonates met the case definition: 6 with infections (among them 3 with cerebral abscesses) and 4 with asymptomatic colonization. Previous antibiotic treatment of the mothers with cefuroxime was the single significant risk factor for colonization or infection (P = .028; odds ratio, 17; 95% confidence interval, 1.3 to 489.5).

Conclusions:

S. marcescens can cause rapidly spreading outbreaks associated with fatal infections in NICUs. With aggressive infection control measures, such outbreaks can be stopped at an early stage. Affected neonates themselves may well be the source of cross-infection to other patients on the ward. Antibiotic treatment of mothers should be reevaluated to avoid unnecessary exposure to antibiotics with the potential of overgrowth of resistant organisms.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 8 , August 2002 , pp. 457 - 461
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Smith, PJ, Brookfield, DS, Shaw, DA, Gray, J. An outbreak of Serratia marcescens infections in a neonatal unit. Lancet 1984;1:151–153.Google Scholar
2.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;3:127–133.Google Scholar
3.Aygun, C, Yigit, S, Gur, D, et al. Serratia marcescens: an emerging microorganism in the neonatal intensive care unit. Turk J Pediatr 2000;42:219–222.Google Scholar
4.Khan, EA, Wafelman, LS, Garcia-Prats, JA, Taber, LH. Serratia marcescens pneumonia, empyema and pneumatocele in a preterm neonate. Pediatr Infect Dis J 1997;16:1003–1005.Google Scholar
5.Sakata, H, Maruyama, S. Serratia marcescens brain abscess in a newborn. Kansenshogaku Zasshi 1998;72:845–848.Google Scholar
6.Berthelot, P, Grattard, F, Amerger, C, et al. Investigation of a nosocomial outbreak due to Serratia marcescens in a maternity hospital. Infect Control Hosp Epidemiol 1999;20:233–236.Google Scholar
7.Archibald, LK, Corl, A, Shah, B, et al. Serratia marcescens outbreak associated with extrinsic contamination of 1% chlorxylenol soap. Infect Control Hosp Epidemiol 1997;18:704–709.Google Scholar
8.Newport, MT, John, JF, Michel, YM, Levkoff, AH. Endemic Serratia marcescens infection in a neonatal intensive care nursery associated with gastrointestinal colonization. Pediatr Infect Dis 1985;4:160–167.Google Scholar
9.Anagnostakis, D. Fitsialos, J, Koutsia, C, Messaritakis, J, Matsaniotis, N. A nursery outbreak of Serratia marcescens infection: evidence of a single source of contamination. American Journal of Diseases in Childhood 1981;135:413–414.Google Scholar
10.von Dolinger Brito, D, Matos, C, Abdalla, V, Filho, DA, Filho, PGP. An outbreak of nosocomial infection caused by ESBLs producing Serratia marcescens in a Brazilian neonatal unit. Brazilian Journal of Infectious Diseases 1999;3:149–155.Google Scholar
11.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;18:357–360.Google Scholar
12.Campbell, JR, Zaccaria, E, Mason, EO Jr, 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;19:924–928.Google Scholar
13.Miranda-Novales, MG, Gordillo-Perez, MG, Gordillo-Santos, F, Leanos-Miranda, B, Villasis-Keever, MA, Villegas-Silva, R. Case-control study of an outbreak of S. marcescens in a neonatal intensive care unit. Rev Invest Clin 1998;50:13–18.Google Scholar
14.van Ogtrop, ML, van Zoeren-Grobben, D, Verbakel-Salomons, EM, van Boven, CP. Serratia marcescens infections in neonatal departments: description of an outbreak and review of the literature. J Hosp Infect 1997;36:95–103.Google Scholar
15.Miranda, G, Kelly, C, Solorzano, F, Leanos, B, Coria, R, Patterson, JE. Use of pulsed-field gel electrophoresis typing to study an outbreak of infection due to Serratia marcescens in a neonatal intensive care unit. J Clin Microbiol 1996;34:3138–3141.Google Scholar
16.Wake, C, Lees, H, Cull, AB. The emergence of Serratia marcescens as a pathogen in a newborn unit. Aust Paediatr J 1986;22:323–326.Google Scholar
17.Cimolai, N, Trombley, C, Wensley, D, LeBlanc, J. Heterogeneous Serratia marcescens genotypes from a nosocomial pediatric outbreak. Chest 1997;111:194–197.Google Scholar
18.Versalovic, J, Koeuth, T, Lupski, JR. Distribution of repetitive DNA sequences in eubacteria and application to fingerprinting of bacterial genomes. Nucleic Acids Res 1991;19:6823–6831.Google Scholar
19.Tullus, K, Berglund, B, Fryklund, B, Kuhn, I, Burman, LG. Influence of antibiotic therapy on faecal carriage of P-fimbriated Escherichia coli and other gram-negative bacteria in neonates. J Antimicrob Chemother 1988; 22:563–568.Google Scholar
20.Jones, BL, Gorman, LJ, Simpson, J, et al. An outbreak of Serratia marcescens in two neonatal intensive care units. J Hosp Infect 2000; 46:314–319.Google Scholar