Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-23T15:59:26.624Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

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.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
2.Archibald, LK, Cori, A, Shah, B, et al. Serratia marcescens outbreak associated with extrinsic contamination of 1% chlorxylenol soap. Infect Control Hosp Epidemiol 1997;18:704–709.Google Scholar
3.van Ogtrop, ML, van Zoeren-Grobben, D, Verbakel-Salomons, EM, van Boven, CP. Serratia marcescens infections in neonatal departments: description of an outbreak and review of the literature. J Hosp Infect 1997;36:95–103.Google Scholar
4.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.Google Scholar
5.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
6.Berthelot, P, Grattard, F, Amerger, C, et al.Investigation of a nosocomial outbreak due to Serratia marcescens in a maternity hospital. Infect Control Hosp Epidemiol 1999;20:233–236.Google Scholar
7.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
8.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
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.Google Scholar
10.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.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.Assadian, O, Berger, A, Aspock, C, Mustafa, S, Kohlhauser, C, Hirschl, AM. Nosocomial outbreak of Serratia marcescens in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2002;23:457–461.Google Scholar
13.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
14.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.CrossRefGoogle ScholarPubMed
15.Jarvis, WR. Epidemiology of nosocomial infections in pediatric patients. Pediatr Infect Dis J 1987;6:344–351.Google Scholar
16.Hejazi, A, Aucken, HM, Falkiner, FR. Epidemiology and susceptibility of Serratia marcescens in a large general hospital over an 8-year period. J Hosp Infect 2000;45:42–46.CrossRefGoogle Scholar
17.Choi, SH, Kim, YS, Chung, JW, et al.Serratia bacteremia in a large university hospital: trends in antibiotic resistance during 10 years and implications for antibiotic use. Infect Control Hosp Epidemiol 2002;23: 740–747.Google Scholar
18.Raymond, J, Aujard, Y. Nosocomial infections in pediatric patients: a European, multicenter prospective study. Infect Control Hosp Epidemiol 2000;21:260–263.Google Scholar
19.Sohn, AH, Garrett, DO, Sinkowitz-Cochran, RL, et al.Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001;139:821–827.Google Scholar
20.Adams-Chapman, I, Stoll, BJ. Prevention of nosocomial infections in the neonatal intensive care unit. Curr Opin Pediatr 2002;14:157–164.Google Scholar
21.Andersen, BM, Lindemann, R, Bergh, K, et al.Spread of methicillin-resistant Staphylococcus aureus in a neonatal intensive unit associated with understaffing, overcrowding and mixing of patients. J Hosp Infect 2002;50:18–24.Google Scholar
22.Archibald, LK, Manning, ML, Bell, LM, Banerjee, S, Jarvis, WR. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J 1997:16:1045–1048.Google Scholar
23.Foca, M, Jakob, K, Whittier, S, et al.Endemie Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med 2000;343:695–700.Google Scholar
24.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
25.Tarnow-Mordi, WO, Hau, C, Warden, A, Shearer, AJ. Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit. Lancet 2000;356:185–189.Google Scholar
26.Henry, B, Plante-Jenkins, C, Ostrowska, K. An outbreak of Serratia marcescens associated with the anesthetic agent propofol. Am J Infect Control 2001;29:312–315.CrossRefGoogle ScholarPubMed
27.Manning, ML, Archibald, LK, Bell, LM, Banerjee, SN, Jarvis, WR. Serratia marcescens transmission in a pediatric intensive care unit: a multifactorial occurrence. Am J Infect Control 2001;29:115–119.Google Scholar
28.Knowles, S, Herra, C, Devitt, E, et al.An outbreak of multiply resistant Serratia marcescens: the importance of persistent carriage. Bone Marrow Transplant 2000;25:873–877.Google Scholar
29.Salmenlinna, S, Lyytikäinen, O, Kotilainen, P, Scotford, R, Siren, E, Vuopio-Varkila, J. Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Finland. Eur J Clin Microbiol Infect Dis 2000; 19:101–107.Google Scholar
30.Dorsey, G, Borneo, HT, Sun, SJ, et al.A heterogeneous outbreak of Enterobacter cloacae and Serratia marcescens infections in a surgical intensive care unit. Infect Control Hosp Epidemiol 2000;21:465–469.Google Scholar