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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

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