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Epidemic Serratia marcescens in a Neonatal Intensive Care Unit: Importance of the Gastrointestinal Tract as a Reservoir

Published online by Cambridge University Press:  02 January 2015

Gordon D. Christensen ,
Sheldon B. Korones ,
Louise Reed ,
Roderick Bulley ,
B. McLaughlin  and
Alan L. Bisno
Gordon D. Christensen*
Affiliation:
Office of Infection Control, University of Tennessee Center for the Health Sciences, Memphis, Tennessee 38163 Departments of internal Medicine, University of Tennessee Center for the Health Sciences, Memphis, Tennessee 38163
Sheldon B. Korones
Affiliation:
Newborn Center, University of Tennessee Center for the Health Sciences, Memphis, Tennessee 38163 Departments of Pediatrics, University of Tennessee Center for the Health Sciences, Memphis, Tennessee 38163
Louise Reed
Affiliation:
Departments of internal Medicine, University of Tennessee Center for the Health Sciences, Memphis, Tennessee 38163
Roderick Bulley
Affiliation:
Clinical Microbiology Laboratories, City of Memphis Hospital, University of Tennessee Center for the Health Sciences, Memphis, Tennessee 38163
B. McLaughlin
Affiliation:
Departments of internal Medicine, University of Tennessee Center for the Health Sciences, Memphis, Tennessee 38163
Alan L. Bisno
Affiliation:
Departments of internal Medicine, University of Tennessee Center for the Health Sciences, Memphis, Tennessee 38163
*
Office of Infection Control, City of Memphis Hospital, 860 Madison Avenue, Memphis, Tennessee 38163
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Abstract

Between March and December of 1979, an outbreak of infections due to multiply antibiotic resistant Serratia marcescens took place in a 50-bed neonatal intensive care unit. Fifteen neonates suffered major infections (sepsis, meningitis and pneumonia) with one death, and 20 suffered minor infections (conjunctivitis, cystitis, wound infections). Epidemiologic investigation failed to reveal a common source; S. marcescens, however, was isolated from an employee's hand, emollient skin cleanser, suction tubing, and three in-use manual infant resuscitation bags. The skin cleanser and equipment-cleaning agents were ineffective against S. marcescens. Asymptomatic, colonized infants were the major reservoir of S. marcescens. These infants were identified by daily cultures of the nose, umbilicus and rectum. The rectal swab most commonly (76%) yielded first-positive cultures in previously uncolonized infants, and was ultimately positive in 92% of colonized infants. A control program was begun by: 1) removing all inanimate sources of S. marcescens; and 2) cohorting patients and staff into a S. marcescens-exposed group and a new patient group. The new patient group of infants was surveyed by daily triple-site cultures for colonization and subsequent transfer to the S. marcescens-exposed group. After four months, the epidemic was controlled and the organism eradicated from the neonatal intensive care unit.

Type
Original-Articles
Information
Infection Control & Hospital Epidemiology , Volume 3 , Issue 2 , March/April 1982 , pp. 127 - 133
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1982

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