Browse > Article

Clinical aspects of an outbreak of Serratia marcescens infections in neonates  

Sung, Min-Jung (Department of Pediatrics, College of Medicine, Pusan National University)
Chang, Chul-Hun (Department of Laboratory Medicine, College of Medicine, Pusan National University)
Yoon, Yeon-Kyong (Department of Infection Control Team, College of Medicine, Pusan National University)
Park, Su-Eun (Department of Pediatrics, College of Medicine, Pusan National University)
Publication Information
Clinical and Experimental Pediatrics / v.49, no.5, 2006 , pp. 500-506 More about this Journal
Abstract
Purpose : We evaluated an outbreak of Serratia marcescens infections in 24 neonates in a neonatal intensive care unit(NICU). Methods : From January to August, 2004 a nosocomial outbreak of S. marcescens occurred in our NICU. We describe the clinical characteristics of the outbreak and analyse the risk factors for infections with S. marcescens. After the outbreak stopped, 7 isolates from blood were typed using rapid amplified polymorphic DNA analysis(RAPD). Results : S. marcescens was isolated from 24 neonates, 19 infected and 5 colonized. Seven out of nineteen neonates had bacteremia, 4 had ventilator associated pneumonia, 4 had purulent conjunctivitis, 2 had UTI, 1 had meningitis and 1 had a wound infection. Three neonates died due to S. marcescens infection, 2 of 3 had ventilator associated pneumonia, 1 had meningitis complicated with abscess. The mortality rate of S. marcescens infection was 15.8%. Factors associated with S. marcescens infections were previous antibiotic therapy, indwelling catheter and use of ventilators. The isolated strains were resistant to most antibiotics, but frequently sensitive to imipenem, bactrim and amikacin. RAPD typing results show that at least 3 epidemic strains were related with this outbreak. But one genotype was predominant type in this outbreak. The control measures were instituted and the outbreak stopped within 2 months. Conclusion : S. marcescens can cause rapidly spreading outbreaks associated with fatal infections in neonates. If S. marcescens is isolated from clinical specimens, meticulous infection control measures and epidemiologic investigations should be done at an early stage of the outbreak.
Keywords
Serratia marcescens; Disease outbreaks; Infant; Newborn;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Vigeant P, Loo VG, Bertrand C, Dixon C, Hollis R, Pfaller MA, et al. An outbreak of Serratia marcescens infections related to contaminated chlorhexidine. Infect Control Hosp Epidemiol 1998;19:791-4   DOI   ScienceOn
2 Newport MT, John JF, Michel YM, Levkoff AH. Endemic Serratia marcescens infection in a neonatal intensive care nursery associated with gastrointestinal colonization. Pediatr Infect Dis 1985;4:160-7   DOI
3 Lam AH, Berry A, deSilva M, Williams G. Intracranial Serratia infection in preterm newborn infants. AJNR Am J Neuroradiol 1984;5:447-51
4 Bando SY, do Valle GR, Martinez MB, Trabulsi LR, Moreira- Filho CA. Characterization of enteroinvasive Escherichia coli and Shigella strains by RAPD analysis. FEMS Microbiol Lett 1998;165:159-65   DOI
5 Christensen GD, Korones SB, Reed 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;3:127-33   DOI
6 Miranda-Novales G, Leanos-Miranda B, Diaz-Ramos R, Gonzalez-Tejeda L, Peregrino-Bejarano L, Villegas-Silva R, et al. An outbreak due to Serratia marcescens in a neonatal intensive care unit typed by 2-day pulsed field gel electrophoresis protocol. Arch Med Res 2003;34:237-41   DOI   ScienceOn
7 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   DOI   ScienceOn
8 Braver DJ, Hauser GJ, Berns L, Siegman-Igra Y, Muhlbauer B. Control of a Serratia marcescens outbreak in a maternity hospital. J Hosp Infect 1987;10:129-37   DOI   ScienceOn
9 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;20:233-6   DOI   ScienceOn
10 Lai KK, Baker SP, Fontecchio SA. Rapid eradication of a cluster of Serratia marcescens in a neonatal intensive care unit : use of epidemiologic chromosome profiling by pulsedfield gel electrophoresis. Infect Control Hosp Epidemiol 2004;25:730-4   DOI   ScienceOn
11 Gransden WR, Webster M, French GL, Phillips I. An outbreak of Serratia marcescens transmitted by contaminated breast pumps in a special care baby unit. J Hosp Infect 1986;7:149-54   DOI   ScienceOn
12 Lewis DA, Hawkey PM, Bennett PM. Antibiotic resistance in Serratia marcescens. Br Med J 1984;288:148-9   DOI
13 Campbell JR, Diacovo T, Baker CJ. Serratia marcescens meningitis in neonates. Pediatr Infect Dis J 1992;11:881-6   DOI   ScienceOn
14 Davis JT, Foltz E, Blakemore WS. Serratia marcescens. A pathogen of increasing clinical importance. JAMA 1970;214: 2190-2   DOI
15 Steppberger K, Walter S, Claros MC, Spencker FB, Kiess W, Rodloff AC, et al. Nosocomial neonatal outbreak of Serratia marcescens--analysis of pathogens by pulsed field gel electrophoresis and polymerase chain reaction. Infection 2002;30:277-81   DOI
16 Sartor C, Jacomo V, Duvivier C, Tissot-Dupont H, Sambuc R, Drancourt M. Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap. Infect Control Hosp Epidemiol 2000;21:196-9   DOI   ScienceOn
17 Gong J, Hogman CF, Hambraeus A, Johansson CS, Eriksson L. Transfusion-associated Serratia marcescens infection : studies of the mechanism of action. Transfusion 1993; 33:802-8   DOI   ScienceOn
18 Casewell MW, Ronan P. Infection with netilmicin resistant Serratia marcescens. Br Med J 1984;288:487
19 Kimpen JL, Brus F, Arends JP, de Vries-Hospers HG. Successful medical treatment of multiple Serratia marcescens brain abscesses in a neonate. Eur J Pediatr 1996;155: 916
20 Messerschmidt A, Prayer D, Olischar M, Pollak A, Birnbacher R. Brain abscesses after Serratia marcescens infection on a neonatal intensive care unit : differences on serial imaging. Neuroradiology 2004;46:148-52   DOI
21 Bollmann R, Halle E, Sokolowska-Kohler W, Grauel EL, Buchholz P, Klare I, et al. Nosocomial infections due to Serratia marcescens--clinical findings, antibiotic susceptibility patterns and fine typing. Infection 1989;17:294-300   DOI
22 Gargallo-Viola D. Enzyme polymorphism, prodigiosin production, and plasmid fingerprints in clinical and naturally occurring isolates of Serratia marcescens. J Clin Microbiol 1989;27:860-8
23 Wake C, Lees H, Cull AB. The emergence of Serratia marcescens as a pathogen in a newborn unit. Aust Paediatr J 1986;22:323-6
24 Acar JF. Serratia marcescens infections. Infect Control 1986;7:273-8   DOI
25 Moloney AC, Quoraishi AH, Parry P, Hall V. A bacteriological examination of breast pumps. J Hosp Infect 1987;9: 169-74   DOI   ScienceOn
26 Gaynes RP, Edwards JR, Jarvis WR, Culver DH, Tolson JS, Martone WJ. Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System. Pediatrics 1996;98: 357-61
27 Sleigh JD. Antibiotic resistance in Serratia marcescens. Br Med J 1983;287:1651-2   DOI
28 Khan EA, Wafelman LS, Garcia-Prats JA, Taber LH. Serratia marcescens pneumonia, empyema and pneumatocele in a preterm neonate. Pediatr Infect Dis J 1997;16:1003-5   DOI   ScienceOn
29 Polyzou A, Sofianou D, Pournaras S, Tsakris A. RAPDfingerprinting of Serratia marcescens after formaldehyde inactivation of DNase activity. Lett Appl Microbiol 2000;30: 419-21   DOI   ScienceOn
30 Kappstein I, Schneider CM, Grundmann H, Scholz R, Janknecht P. Long-lasting contamination of a vitrectomy apparatus with Serratia marcescens. Infect Control Hosp Epidemiol 1999;20:192-5   DOI   ScienceOn
31 Cook LN, Davis RS, Stover BH. Outbreak of amikacinresistant Enterobacteriaceae in an intensive care nursery. Pediatrics 1980;65:264-8
32 Zaidi M, Sifuentes J, Bobadilla M, Moncada 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   DOI   ScienceOn
33 Sarvikivi E, Lyytikainen O, Salmenlinna S, Vuopio-Varkila J, Luukkainen P, Tarkka E, et al. Clustering of Serratia marcescens infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004;25:723-9   DOI   ScienceOn