Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-29T01:07:55.789Z Has data issue: false hasContentIssue false
  • English
  • Français

Epidemiological Analysis Defining Concurrent Outbreaks of Serratia marcescens and Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive-Care Unit

Published online by Cambridge University Press:  02 January 2015

Judith R. Campbell ,
Elena Zaccaria ,
Edward O. Mason Jr  and
Carol J. Baker
Judith R. Campbell*
Affiliation:
Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine
Elena Zaccaria
Affiliation:
Department of Infection Control, Columbia Woman's Hospital of Texas, Houston, Texas
Edward O. Mason Jr
Affiliation:
Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine
Carol J. Baker
Affiliation:
Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine Department of Microbiology and Immunology, Baylor College of Medicine Department of Infection Control, Columbia Woman's Hospital of Texas, Houston, Texas
*
Baylor College of Medicine, Department of Pediatrics, One Baylor Plaza, Room 312E, Houston, TX 77030
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe the epidemiology, interventions, and molecular typing methods used during the investigation and control of concurrent outbreaks of Serratia marcescens and methicillin-resistant Staphylococcus aureus (MRSA) infections in a neonatal intensive-care unit (NICU).

Setting:

A 206-bed women's and infants' hospital with a 48-bed NICU.

Design:

A 22-week, prospective, descriptive study of all NICU infants with S marcescens or MRSA infection or colonization. Repetitive polymerase chain reaction (rep PCR) and pulsed-field gel electrophoresis (PFGE), respectively, were applied to the typing of S marcescens and MRSA isolates.

Interventions:

Infants with S marcescens or MRSA infection or colonization were placed in isolation; all other infants were cohorted. A multidisciplinary task force implemented education for all hospital and medical staff regarding policies essential for outbreak control. Changes in physical setting and patient contact procedure were required to promote adherence to existing policies.

Results:

Two premature infants had S marcescens infection, and five were colonized; rep PCR verified that both invasive and three of five colonizing isolates were related genotypically. Five bacteremic and 10 MRSA-colonized infants were identified; PFGE confirmed that 12 of the isolates had similar electrophoretic patterns. S marcescens infection was eliminated from the NICU 3 weeks after interventions were initiated. MRSA infections also were eliminated, and MRSA colonization fell to below pre-outbreak rates within 8 weeks. Despite a 100% increase in NICU patient days per month during the subsequent 2 years, no further clusters of S marcescens or MRSA infection have occurred.

Conclusions:

Concurrent outbreaks of S marcescens and MRSA in an NICU were confirmed by genotyping of strains. Control was achieved by isolation and cohorting of patients and strict adherence to NICU policies and procedures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 12 , December 1998 , pp. 924 - 928
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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. Gaynes, RP, Edwards, JR, Jarvis, WR, Culver, DH, Tolson, JS, Martone, WJ. Nosocomial infections among neonates in high-risk nurseries in the United States. Pediatrics 1996;98:357–361.Google Scholar
2. McCormack, RC, Kunin, CM. Control of a single source nursery epidemic due to Serratia marcescens. Pediatrics 1966;37:750–755.Google Scholar
3. Stamm, WE, Kolff, CA, Dones, EM, Javaris, R, Anderson, RL, Farmer, JJ III, et al. A nursery outbreak caused by Serratia marcescens—scalp-vein needles as a portal of entry. J Pediatr 1976;89:96–99.Google Scholar
4. Price, EH, Brain, A, Dickson, JA. An outbreak of infection with a gentamicin and methicillin-resistant Staphylococcus aureus in a neonatal unit. J Hosp Infect 1980;1(3):221–228.Google Scholar
5. Anagnostakis, D, Fitsialos, J, Koutsia, C, Messaritakis, J, Matsaniotis, N. A nursery outbreak of Serratia marcescens infection. Am J Dis Child 1981;135:413–414.Google Scholar
6. Dunkle, LM, Naqvi, SH, McCallum, R, Lofgren, JP. Eradication of epidemic methicillin-gentamicin-resistant Staphylococcus aureus in an intensivecare nursery. Am J Med 1981;70:455–458.Google Scholar
7. 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 reser voir. Infect Control 1982;3:127–133.Google Scholar
8. Reboli, A, John, J Jr, Levkoff, AH. Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit. Am J Dis Child 1989;143:34–39.Google Scholar
9. Zaidi, M, Sifuentes, J, Bobadilla, M, Moncada, D, Ponce de Leon, S. Epidemic of Serratia marcescens bacteremia and meningitis in a neonatal unit in Mexico City. Infect Control Hosp Epidemiol 1989;10:14–20.Google Scholar
10. Campbell, JR, Diacovo, T, Baker, CJ. Serratia marcescens meningitis in neonates. Pediatr Infect Dis J 1992;11:881–886.Google Scholar
11. Haley, RW, Cushion, NB, Tenover, FC, Bannerman, TL, Dryer, D, Ross, J, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614–624.Google Scholar
12. Back, NA, Linnemann, CC Jr, Staneck, JL, Kotagal, UR. Control of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit: use of intensive microbiologic surveillance and mupirocin. Infect Control Hosp Epidemiol 1996;17:227–231.Google Scholar
13. Versalovic, J, Schneider, M, de Bruijn, FJ, Lupski, JR. Genomic fingerprinting of bacteria using repetitive sequence-based polymerase chain reaction. Methods in Molecular and Cellular Biology 1994;5:25–40.Google Scholar
14. Tenover, FC, Arbeit, RD, Goering, RV, Mickelsen, PA, Murray, BE, Persing, DH, et al. Interpreting chromosomal DN. restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
15. Tenover, FC, Arbeit, R, Archer, G, Biddle, J, Byrne, S, Goering, R, et al. Comparison of traditional and molecular methods of typing isolates of Staphylococcus aureus. J Clin Microbiol 1994;32:407–415.Google Scholar
16. Hemming, VG, Overall, JC, Britt, MR. Nosocomial infections in a newborn intensivecare unit. N Engl J Med 1976;294:1310–1316.Google Scholar
17. Baker, CJ. Nosocomial septicemia and meningitis in neonates. Am J Med 1981;70:698–701.Google Scholar
18. Barrett, FF, McGehee, RF Jr, Finland, M. Methicillin-resistant Staphylococcus aureus at Boston City Hospital: bacteriologic and epidemiologic observations. N Engl J Med 1968;279:441–448.Google Scholar
19. Graham, DR, Correa-Villasenor, A, Anderson, RL, Vollman, JH, Baine, WB. Epidemic neonatal gentamicin-methicillin-resistant Staphylococcus aureus infection associated with nonspecific topical use of gentamicin. J Pediatr 1980;97:972–978.Google Scholar
20. Goldman, DA, Durbin, WA Jr, Freeman, J. Nosocomial infections in a neonatal intensive care unit. J Infect Dis 1981;144:449–459.Google Scholar
21. Haley, RW, Bregman, DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis 1982;145:875–885.CrossRefGoogle Scholar
22. Gezon, HM, Schaberg, MJ, Klein, JO. Concurrent epidemics of Staphylococcus aureus and group A streptococcus disease in a newborn nursery—control with penicillin G and hexachlorophene bathing. Pediatrics 1973;51:383–390.Google Scholar
23. Wilson, CS, Stevenson, DK, Arvin, AM. A concurrent epidemic of respiratory syncytial virus and echovirus 7 infections in an intensive care nursery. Pediatr Infect Dis J 1989;8:24–29.Google Scholar
24. Boyce, JM. Preventing staphylococcal infections by eradicating nasal carriage of Staphylococcus aureus: proceeding with caution. Infect Control Hosp Epidemiol 1996;17:775–779.Google Scholar
25. Lessing, MPA, Jordens, JZ, Bowler, ICJ. When should healthcare workers be screened for methicillin-resistant Staphylococcus aureus? J Hosp Infect 1996;34:205–210.Google Scholar