Hostname: page-component-745bb68f8f-lrblm Total loading time: 0 Render date: 2025-01-11T05:31:10.703Z Has data issue: false hasContentIssue false
  • English
  • Français

Outbreak of Multidrug-Resistant Serratia marcescens Infection in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Lisa L. Maragakis ,
Amy Winkler ,
Margaret G. Tucker ,
Sara E. Cosgrove ,
Tracy Ross ,
Edward Lawson ,
Karen C. Carroll  and
Trish M. Perl
Lisa L. Maragakis*
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Amy Winkler
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Margaret G. Tucker
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Sara E. Cosgrove
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Tracy Ross
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Edward Lawson
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Karen C. Carroll
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Trish M. Perl
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
*
Department of Hospital Epidemiology and Infection Control, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Osier 425, Baltimore, MD 21287, ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Serratia marcescens causes healthcare-associated infections and significant morbidity and mortality in neonatal intensive care units (NICUs). We report the investigation and control of an outbreak of multidrug-resistant (MDR) S. marcescens infection at an NICU.

Methods.

An outbreak investigation and a case-control study were undertaken at a 36-bed NICU in a tertiary care hospital in Baltimore, Maryland, for the period from October 2004 through February 2005. The outbreak investigation included case identification, review of medical records, environmental cultures, patient surveillance cultures, personnel hand cultures, and pulsed-field gel electrophoresis (PFGE). The case-control study included case identification and review of medical records. Infection control measures were implemented. Eighteen NICU neonates had cultures that grew MDR S. marcescens during the study period. The case-control study included 16 patients with the outbreak strain or an unidentified strain of MDR S. marcescens and 32 control patients not infected and/or colonized with MDR S. marcescens, treated in the NICU for at least 48 hours during the study period.

Results.

PFGE analysis identified a single strain of MDR S. marcescens that infected or colonized 15 patients. Two patients had unique strains, and 1 patient's isolate could not be subtyped. An unrelated MDR S. marcescens isolate was recovered from a sink drain. Exposure to inhalational therapy was an independent risk factor for MDR S. marcescens acquisition after adjusting for birth weight. Extensive investigation failed to reveal a point source for the outbreak.

Conclusion.

A single epidemic strain of MDR S. marcescens spread rapidly and threatened to become endemic in this NICU. Transient carriage on the hands of healthcare personnel or on respiratory care equipment was the likely mode of transmission. Cohorting patients and staff, at the cost of bed closures and additional personnel, interrupted transmission and halted the outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 5 , May 2008 , pp. 418 - 423
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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.Uduman, SA, Farrukh, AS, Nath, KN, et al.An outbreak of Serratia marcescens infection in a special-care baby unit of a community hospital in United Arab Emirates: the importance of the air conditioner duct as a nosocomial reservoir. J Hosp Infect 2002;52:175–180.Google Scholar
2.Cullen, MM, Trail, A, Robinson, M, Keaney, M, Chadwick, PR. Serratia marcescens outbreak in a neonatal intensive care unit prompting review of decontamination of laryngoscopes. J Hosp Infect 2005;59:68–70.Google Scholar
3.Jang, TN, Fung, CP, Yang, TL, Shen, SH, Huang, CS, Lee, SH. Use of pulsed-field gel electrophoresis to investigate an outbreak of Serratia marcescens infection in a neonatal intensive care unit. J Hosp Infect 2001;48:13–19.Google Scholar
4.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
5.Lai, KK, Baker, SP, Fontecchio, SA. Rapid eradication of a cluster of Serratia marcescens in a neonatal intensive care unit: use of epidemiologic chromosome profiling by pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 2004;25:730–734.CrossRefGoogle Scholar
6.Sarvikivi, E, Lyytikainen, O, Salmenlinna, S, et al.Clustering of Serratia marcescens infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004;25:723–729.Google Scholar
7.Steppberger, K, Walter, S, Claros, MC, et al.Nosocomial neonatal outbreak of Serratia marcescens—analysis of pathogens by pulsed field gel electrophoresis and polymerase chain reaction. Infection 2002;30:277–281.Google Scholar
8.Villari, P, Crispino, M, Salvadori, A, Scarcella, A. Molecular epidemiology of an outbreak of Serratia marcescens in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2001;22:630–634.CrossRefGoogle Scholar
9.Prasad, GA, Jones, PG, Michaels, J, Garland, JS, Shivpuri, CR. Outbreak of Serratia marcescens infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2001;22:303–305.CrossRefGoogle Scholar
10.Milisavljevic, V, Wu, F, Larson, E, et al.Molecular epidemiology of Serratia marcescens outbreaks in two neonatal intensive care units. Infect Control Hosp Epidemiol 2004;25:719–721.Google Scholar
11.Fleisch, F, Zimmermann-Baer, U, Zbinden, R, et al.Three consecutive outbreaks of Serratia marcescens in a neonatal intensive care unit. Clin Infect Dis 2002;34:767–773.Google Scholar
12.Stoli, BJ, Hansen, N, Fanaroff, AA, et al.Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285–291.Google Scholar
13.Gransden, WR, Webster, M, French, GL, Phillips, I. An outbreak of Serratia marcescens transmitted by contaminated breast pumps in a special care baby unit. J Hosp Infect 1986;7:149–154.Google Scholar
14.Sartor, C, Jacomo, V, Duvivier, C, Tissot-Dupont, H, Sambuc, R, Drancourt, M. Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap. Infect Control Hosp Epidemiol 2000;21:196–199.Google Scholar
15.Waters, V, Larson, E, Wu, F, et al.Molecular epidemiology of gram-negative bacilli from infected neonates and health care workers' hands in neonatal intensive care units. Clin Infect Dis 2004;38:1682–1687.CrossRefGoogle ScholarPubMed
16.Almuneef, MA, Baltimore, RS, Farrel, PA, Reagan-Cirincione, P, Dembry, LM. Molecular typing demonstrating transmission of gram-negative rods in a neonatal intensive care unit in the absence of a recognized epidemic. Clin Infect Dis 2001;32:220–227.CrossRefGoogle Scholar
17.FDA Public Health Notification: Precautions in Using the Reintroduced Vapotherm 2000i Respiratory Gas Humidification System. FDA Web site. 2007. http://www.fda.gov/cdrh/safety/020107-vapotherm.html. Accessed October 19, 2007.Google Scholar
18.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.Google Scholar
19.Harbarth, S, Sudre, P, Dharan, S, Cadenas, M, Pittet, D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol 1999;20:598–603.Google Scholar