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Clustering of Serratia marcescens Infections in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Emmi Sarvikivi ,
Outi Lyytikäinen ,
Saara Salmenlinna ,
Jaana Vuopio-Varkila ,
Päivi Luukkainen ,
Eveliina Tarkka  and
Harri Saxén
Emmi Sarvikivi*
Affiliation:
Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
Outi Lyytikäinen
Affiliation:
Department of Infectious Disease Epidemiology, National Public Health Institute (KTL), Helsinki, Finland
Saara Salmenlinna
Affiliation:
Department of Microbiology, National Public Health Institute (KTL), Helsinki, Finland
Jaana Vuopio-Varkila
Affiliation:
Division of Clinical Microbiology, Helsinki University Central Hospital, Helsinki, Finland Department of Microbiology, National Public Health Institute (KTL), Helsinki, Finland
Päivi Luukkainen
Affiliation:
Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
Eveliina Tarkka
Affiliation:
Division of Clinical Microbiology, Helsinki University Central Hospital, Helsinki, Finland
Harri Saxén
Affiliation:
Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
*
Hospital for Children and Adolescents, P.O. Box 280, Lastenlinnantie 11 C 29, 00029 HUS, Helsinki, Finland
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Abstract

Objectives:

To study clusters of infections caused by Serratia marcescens in a neonatal intensive care unit (NICU) and to determine risk factors for S. marcescens infection or colonization.

Design:

Genotyping of S. marcescens isolates was performed by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted.

Setting:

A tertiary-care pediatric hospital with a 16-bed NICU.

Patients:

All neonates with at least one culture positive for S. marcescens in the NICU during December 1999 to July 2002. Case-patients (n = 11) treated in the NICU during December 1999 to February 2000 were included in the case-control study. Neonates treated in the NICU for at least 72 hours during the same period with cultures negative for S. marcescens were used as control-patients (n = 27).

Results:

S. marcescens was cultured from 19 neonates; 9 were infected and 10 were colonized. PFGE analysis identified three epidemic strains; each cluster consisted of identical isolates, except one isolate in the first cluster that was different. The risk factors identified were low birth weight, prematurity, prolonged respiratory therapy, prolonged use of antibiotics, and maternal infection prior to delivery. Overcrowding and understaffing were recorded simultaneously with the clusters.

Conclusions:

PFGE analysis showed three independent clusters. Several factors contributed to spread of the epidemic strains: (1) there were many severely premature and susceptible neonates, (2) the NICU was overcrowded during the clusters, and (3) transmission was likely to occur via the hands of staff. Cohorting and improvement of routine infection control measures led to the cessation of each cluster.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 9 , September 2004 , pp. 723 - 729
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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