Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-02T21:24:27.172Z Has data issue: false hasContentIssue false
  • English
  • Français

Molecular Epidemiology of an Outbreak of Serratia marcescens in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Paolo Villari ,
Margherita Crispino ,
Alessandra Salvadori  and
Alda Scarcella
Paolo Villari*
Affiliation:
Department of Experimental Medicine and Pathology, University “La Sapienza, ”Rome, Italy
Margherita Crispino
Affiliation:
Departments of Health and Preventive Sciences, University “Federico II, ” Naples, Italy
Alessandra Salvadori
Affiliation:
Departments of Health and Preventive Sciences, University “Federico II, ” Naples, Italy
Alda Scarcella
Affiliation:
Pediatrics, University “Federico II, ” Naples, Italy
*
Department of Experimental Medicine and Pathology, University “La Sapienza, ” Viale Regina Elena 324, 00161 Rome, Italy
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate and control a biphasic outbreak of Serratia marcescens in a neonatal intensive care unit (NICU).

Design:

Epidemiological and laboratory investigation of the outbreak.

Setting:

The NICU of the 1,470-bed teaching hospital of the University “Federico II,” Naples, Italy.

Patients:

The outbreak involved 56 cases of colonization by S marcescens over a 15-month period, with two epidemic peaks of 6 and 3 months, respectively. Fourteen (25%) of the 56 colonized infants developed clinical infections, 50% of which were major (sepsis, meningitis, or pneumonia).

Methods:

Epidemiological and microbiological investigations, analysis of macrorestriction pattern of genomic DNA through pulsed-field gel electrophoresis (PFGE) of clinical and environmental isolates, and institution of infection control measures.

Results:

Analysis of macrorestriction patterns of genomic DNA by PFGE demonstrated that the vast majority of S marcescens isolates, including three environmental strains isolated from two handwashing disinfectants and the hands of a nurse, were of the same clonal type. The successful control of the outbreak was achieved through cohorting of noncolonized infants, isolation of S marcescens-infected and -colonized infants, and an intense educational program that emphasized the need for adherence to glove use and handwashing policies. The NICU remained open to new admissions.

Conclusions:

Outbreaks caused by S marcescens are very difficult to eradicate. An infection control program that includes molecular typing of microorganisms and the proper dissemination among staff members of the typing results is likely to be very effective in reducing NICU-acquired infections and in controlling outbreaks caused by S marcescens, as well as other multiresistant bacteria.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 10 , October 2001 , pp. 630 - 634
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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. McCormack, RC, Kunin, CM. Control of a single source nursery epidemic due to Serratia marcescens . Pediatrics 1966;37:750–755.CrossRefGoogle ScholarPubMed
2. Stamm, WE, Kolff, CA, Munoz Dones, E, Javariz, R, Anderson, RL, Former, JJ III, et al. A nursery outbreak by Serratia marcescens scalp-vein needles as a portal of entry. J Pediatr 1976;89:96–99.CrossRefGoogle ScholarPubMed
3. Cook, LN, Davis, RS, Stover, BH. Outbreak of amikacin-resistant Enterobacteriaceae in an intensive care nursery. Pediatrics 1980;65:264–268.Google Scholar
4. Anagnostakis, D, Fitsialos, J, Koutsia, C, Messaritakis, J, Matsaniotis, N. A nursery outbreak of Serratia marcescens infection, evidence of a single source of contamination. Am J Dis Child 1981;135:413–414.Google Scholar
5. Christensen, GD, Korones, SB, Reid, L, Bulley, R, McLaughlin, B, Bisno, AL. Epidemic Serratia marcescens in a neonatal intensive care unit: importance of the gastrointestinal tract as a reservoir. Infect Control 1982;3:127–133.Google Scholar
6. Scheidt, A, Drusin, LM, Krauss, AN, Machalek, SG. Nosocomial outbreak of resistant Serratia in a neonatal intensive care unit. NY State J Med 1982;82:1188–1191.Google Scholar
7. Lewis, DA, Hawkey, PM, Watts, JA, Speller, DCE, Primavesi, RJ, Fleming, PJ, et al. Infection with netilmicin resistant Serratia marcescens in a special care baby unit. BMJ 1983;287:1701–1705.CrossRefGoogle Scholar
8. Duggan, TG, Leng, RA, Hancock, BM, Cursons, RT. Serratia marcescens in a newborn unit-microbiological features. Pathology 1984;16:189–191.Google Scholar
9. Montanaro, D, Grasso, GM, Annino, I, de Ruggiero, N, Scarcella, A, Schioppa, F. Epidemiological and bacteriological investigation of Serratia marcescens epidemic in a nursery and in a neonatal intensive care unit. J Hyg (Camb) 1984;93:67–78.Google Scholar
10. Smith, PJ, Brookfield, DSK, Shaw, DA, Gray, J. An outbreak of Serratia marcescens infection in a neonatal unit. Lancet 1984;1:151–153.Google Scholar
11. Newport, MT, John, JF, Michael, YM, Levkoff, AH. Endemic Serratia marcescens infection in a neonatal intensive care nursery associated with gastrointestinal colonization. Pediatr Infect Dis 1985;4:160–167.CrossRefGoogle Scholar
12. Wake, C, Lees, H, Cull, AB. The emergence of Serratia marcescens as a pathogen in a newborn unit. Aust Pediatr J 1986;22:323–326.Google Scholar
13. Braver, DJ, Hauser, GJ, Berns, L, Siegman-Ingra, Y, Muhlbauer, B. Control of a Serratia marcescens outbreak in a maternity hospital. J Hosp Infect 1987;10:129–137.CrossRefGoogle Scholar
14. Bollmann, R, Halle, E, Sokolowska-Kohler, W, Grauel, EL, Buchholz, P, Hare, I, et al. Nosocomial infections due to Serratia marcescens—clinical findings, antibiotic susceptibility patterns and fine typing. Infection 1989;17:294–300.Google Scholar
15. Zaidi, M, Sifuentes, J, Bobadilla, M, Muncada, 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
16. McGeer, A, Low, DE, Penner, J, Ng, J, Goldman, C, Simor, AE. Use of molecular typing to study the epidemiology of Serratia marcescens . J Clin Microbiol 1990;28:55–58.Google Scholar
17. Pegues, DA, Arathoon, EG, Samayoa, B, Del Valle, GT, Anderson, RL, Riddle, CF, et al. Epidemic gram-negative bacteria in a neonatal intensive care unit in Guatemala. Am J Infect Control 1994;22:163–171.Google Scholar
18. Miranda, G, Kelly, C, Solorzano, F, Leanos, B, Coria, R, Patterson, JE. Use of pulsed-field gel electrophoresis typing to study an outbreak of infection due to Serratia marcescens in a neonatal intensive care unit. J Clin Microbiol 1996;34:3138–3141.Google Scholar
19. Archibald, LK, Corl, A, Shah, B, Schulte, M, Arduino, MJ, Aguero, S, et al. Serratia marcescens outbreak associated with extrinsic contamination of 1% chloroxylenol soap. Infect Control Hosp Epidemiol 1997;18:704–709.Google Scholar
20. van Ogtrop, ML, van Zoeren-Grobben, D, Verbakel-Salomons, EMA, van Boven, CPA. Serratia marcescens infections in neonatal departments: description of an outbreak and review of the literature. J Hosp Infect 1997;36:95–103.CrossRefGoogle ScholarPubMed
21. Campbell, JR, Zaccaria, E, Mason, EO Jr, Baker, CJ. Epidemiological analysis defining concurrent outbreaks of Serratia marcescens and methicillin-resistant Staphylococcus aureus in a neonatal intensive-care unit. Infect Control Hosp Epidemiol 1998;19:924–928.CrossRefGoogle Scholar
22. Berthelot, P, Grattard, F, Amerger, C, Frery, MC, Lucht, F, Pozzetto, B, et al. Investigation of a nosocomial outbreak due to Serratia marcescens in a maternity hospital. Infect Control Hosp Epidemiol 1999;20:233–236.CrossRefGoogle Scholar
23. Hoyen, C, Rice, L, Conte, S, Jacobs, MR, Walsh-Sukys, M, Toltzis, P. Use of real time pulsed field gel electrophoresis to guide interventions during a nursery outbreak of Serratia marcescens infection. Pediatr Infect Dis J 1999;18:357–360.CrossRefGoogle ScholarPubMed
24. Gaynes, RP, Horan, TC. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins Co; 1996:1017–1031.Google Scholar
25. Villari, P, Iacuzio, L, Torre, I, Scarcella, A. Molecular epidemiology as an effective tool in the surveillance of infections in the neonatal intensive care unit. J Infect 1998;37:274–281.Google Scholar
26. Villari, P, Sarnataro, C, Iacuzio, L. Molecular epidemiology of Staphylococcus epidermidis in a neonatal intensive care unit over a three-year period. J Clin Microbiol 2000;38:1740–1746.Google Scholar
27. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. Approved Standard M2-A5. 5th ed. Villanova, PA: NCCLS; 1993.Google Scholar
28. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Sixth Informational Supplement: M100-S6. Villanova, PA: NCCLS; 1995.Google Scholar
29. Legrand, P, Fournier, G, Buré, A, Jarlier, V, Nicolas, MH, Decré, D, Duval, J, Philippon, A. Detection of extended broad-spectrum β-lactamases in Enterobacteriaceae in four French hospitals. Eur J Clin Microbiol Infect Dis 1989;8:527–529.CrossRefGoogle ScholarPubMed
30. Tenover, FC, Arbeit, RD, Goering, RU, Mickelsen, PA, Murray, BE, Persing, DH, Swaminathan, B. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
31. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990-May 1999, issued June 1999. Am J Infect Control 1999;27:520–532.Google Scholar
32. Shi, ZY, Iiu, PYF, Lau, Yj, Lin, YH, Hu, BS. Use of pulsed-field gel electrophoresis to investigate an outbreak of Serratia marcescens . J Clin Microbiol 1997;35:325–327.CrossRefGoogle ScholarPubMed
33. Iivermore, DM. β-lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995;8:557–584.Google Scholar
34. Coudron, PE, Moland, ES, Sanders, CC. Occurrence and detection of extended spectrum β-lactamases in members of the family Enterobacteriaceae at a Veterans Medical Center: seek and you may find. J Clin Microbiol 1997;35:2593–2597.Google Scholar
35. Palucha, A, Mikiewicz, B, Hryniewicz, W, Gniadkowsky, M. Concurrent outbreaks of extended-spectrum p-lactamase-producing organisms of the family Enterobacteriaceae in a Warsaw hospital. J Antimicrob Chemother 1999;44:489–499.CrossRefGoogle Scholar