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Nosocomial Serratia marcescens Outbreak in Osaka, Japan, From 1999 to 2000

Published online by Cambridge University Press:  02 January 2015

Hiroshi Takahashi ,
Michael H. Kramer ,
Yoshinori Yasui ,
Hayato Fujii ,
Katsumi Nakase ,
Kazunori Ikeda ,
Tatsuya Imai ,
Akiko Okazawa ,
Tomoyuki Tanaka  and
Takaaki Ohyama
...Show all authors
Hiroshi Takahashi*
Affiliation:
Field Epidemiology Training Program Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
Michael H. Kramer
Affiliation:
Field Epidemiology Training Program
Yoshinori Yasui
Affiliation:
Sakai City Health Center, Sakai, Osaka, Japan
Hayato Fujii
Affiliation:
Field Epidemiology Training Program
Katsumi Nakase
Affiliation:
Field Epidemiology Training Program
Kazunori Ikeda
Affiliation:
Sakai City Health Center, Sakai, Osaka, Japan
Tatsuya Imai
Affiliation:
Sakai City Health Center, Sakai, Osaka, Japan
Akiko Okazawa
Affiliation:
Sakai City Health Center, Sakai, Osaka, Japan
Tomoyuki Tanaka
Affiliation:
Sakai City Institute of Public Health, Sakai, Osaka, Japan
Takaaki Ohyama
Affiliation:
Field Epidemiology Training Program Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
Nobuhiko Okabe
Affiliation:
Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
*
Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-8640, Japan
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Abstract

Objectives:

To investigate and control an outbreak of bloodstream infections (BSIs) caused by Serratia marcescens and to identify risk factors for respiratory colonization or infection with S. marcescens.

Design:

Epidemiologic investigation, including review of medical and laboratory records, procedural investigations, pulsed-field gel electrophoresis (PFGE) typing of environmental and patient isolates, statistical study, and recommendation of control measures.

Patients and Setting:

All patients admitted to a 380-bed, secondary-care hospital in Osaka Prefecture, Japan, from July 1999 through June 2000 (study period).

Results:

Seventy-one patients were colonized or infected with S. marcescens; 3 patients who developed primary BSIs on the same ward within 5 days in June 2000 had isolates with indistinguishable PFGE patterns and indwelling intravenous catheters for more than 5 days. On multivariate analysis, among 36 case-patients with positive sputum specimens and 95 control-patients, being bedridden (odds ratio [OR], 15.91; 95% confidence interval [CI95], 4.17-60.77), receiving mechanical ventilation (OR, 7.86; CI95, 2.27-27.16), being older than 80 years (OR, 3.12; CI95, 1.05-9.27), and receiving oral cleaning care (OR 3.10; CI95, 1-9.58) were significant risk factors. S. marcescens was isolated from the fluid tanks of three nebulizers and a liquid soap dispenser. The hospital did not have written infection control standards, and many infection control practices were found to be inadequate (eg, respiratory equipment was used without disinfection between patients).

Conclusions:

Poor hospital hygiene and the lack of standard infection control measures contributed to infections hospital-wide. Recommendations to the hospital included adoption of written infection control policies.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 2 , February 2004 , pp. 156 - 161
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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