medigraphic.com
Boletín Médico del Hospital Infantil de México

2007, Number 1

<< Back Next >>

Bol Med Hosp Infant Mex 2007; 64 (1)

Nosocomial bacteremia and gastrointestinal tract colonization outbreak of Serratia marcescens in a Neonatal Intensive Care Unit.

Romano-Mazzotti L, Murguía-Peniche T, Pérez-Robles VM, Santos-Preciado JI, Alcántar-Curiel D, Alpuche-Aranda CM

Language: Spanish
References: 33
Page: 9-17
PDF size: 187.12 Kb.


ABSTRACT

Introduction. We investigated an outbreak of Serratia marcescens bloodstream infection (BSI)/colonization in patients from a Neonatal Intensive Care Unit (NICU) in a tertiary care pediatric Hospital.
Material and methods. May 17 through June 17, 2006 was considered as the study period. A case was defined as any patient with S. marcescens-positive culture in the NICU during the outbreak period because no S. marcescens was identified in this area within 6 month of pre-epidemic period. To identify risk factors we compared patients with S. marcescens positive-cultures with controls exposed to the cases during the outbreak period without positive cultures. Genotyping of all S. marcescens isolates were evaluated by restriction endonuclease and pulsed-field gel electrophoresis (PFGE).
Results. Seven S. marcescens positive cultures were identified; the index case had a positive blood culture with diagnosis of BSI, followed by a patient with CSF positive culture with diagnosis of ventriculitis and BSI. The remaining 5 cases had concurrent S. marcescens isolates from stool cultures (colonization). Environmental cultures (water, IV solutions and inanimate surfaces) were negative for these bacteria. According to univariate analysis, patients with S. marcescens stayed in the NICU longer than controls (52 vs 27.9 days, P ‹ 0.05), they were more likely to have an orogastric tube in place and to receive enteral nutrition. All the S. marcescens had an identical pattern of PFGE analysis. Contact precaution, including hand washing, was reinforced in addition to temporary closing of the NICU in order to control the outbreak.
Conclusions. This outbreak of S. marcescens was studied using epidemiological analysis and molecular biology techniques, confirming cross-transmission between cases associated to a possible gastrointestinal reservoir. Our findings underscore the importance of hand hygiene and other contact precaution methods in hospital settings, such as NICU.


REFERENCES

  1. David MD, Weller TM, Lambert P, Fraise AP. An outbreak of Serratia marcescens on the neonatal unit: a tale of two clones. J Hosp Infect. 2006; 63: 27-33.

  2. Dhiraputra C, Tribuddharat C, Pongpech P, Chokephaibulkit K, Danchaivijitr S. Endemic Serratia marcescens in a neonatal intensive care unit. J Med Assoc Thai. 2005; 88 Supl 10: S10-3.

  3. Sarvikivi E, Lyytikainen O, Salmenlinna S. Clustering of Serratia marcescens infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2004; 25: 723-9.

  4. Milisavljevic V, Wu F, Larson E. Molecular epidemiology of Serratia marcescens outbreaks in two neonatal intensive care units. Infect Control Hosp Epidemiol. 2004; 25: 719-21.

  5. 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 pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol. 2004; 25: 730-4.

  6. Fleisch F, Zimmermann-Baer U, Zbinden R. Three consecutive outbreaks of Serratia marcescens in a neonatal intensive care unit. Clin Infect Dis. 2002; 34: 767-73.

  7. 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: 630-4.

  8. 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: 303-5.

  9. 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.

  10. Miranda G, Kelly C, Solórzano 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: 3138-41.

  11. Miranda-Novales G, Leanos-Miranda B, Diaz-Ramos R. 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.

  12. Steppberger K, Walter S, Claros MC. Nosocomial neonatal outbreak of Serratia marcescens—analysis of pathogens by pulsed field gel electrophoresis and polymerase chain reaction. Infection. 2002; 30: 277-81.

  13. Muñoz JM, Macias AE. Nosocomial outbreak of Serratia marcescens in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2003; 24: 312; author reply -3.

  14. Jones BL, Gorman LJ, Simpson J. An outbreak of Serratia marcescens in two neonatal intensive care units. J Hosp Infect. 2000; 46: 314-9.

  15. Alfizah H, Nordiah AJ, Rozaidi WS. Using pulsed-field gel electrophoresis in the molecular investigation of an outbreak of Serratia marcescens infection in an intensive care unit. Singapore Med J. 2004; 45: 214-8.

  16. Krawczyk B, Naumiuk L, Lewandowski K. Evaluation and comparison of random amplification of polymorphic DNA, pulsed-field gel electrophoresis and ADSRRS-fingerprinting for typing Serratia marcescens outbreaks. FEMS Immunol Med Microbiol. 2003; 38: 241-8.

  17. 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: 13-9.

  18. Irmscher HM, Fischer R, Beer W, Seltmann G. Characterization of nosocomial Serratia marcescens isolates: comparison of Fourier-transform infrared spectroscopy with pulsed-field gel electrophoresis of genomic DNA fragments and multilocus enzyme electrophoresis. Zentralbl Bakteriol. 1999; 289: 249-63.

  19. Chetoui H, Delhalle E, Melin P, et al. Typing of nosocomial strains of Serratia marcescens: comparison of pulsed-field gel electrophoresis of macrorestriction fragments with biotyping, esterase typing and ribotyping. Res Microbiol. 1998; 149: 137-43.

  20. Tenover FC, Arbeit RD, Goering RV. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995; 33: 2233-9.

  21. Makhoul IR, Sujov P, Smolkin T, Lusky A, Reichman B. Pathogen-specific early mortality in very low birth weight infants with late-onset sepsis: a national survey. Clin Infect Dis. 2005; 40: 218-24.

  22. Cullen MM, Trail A, Robinson M, Keaney M, Chadwick PR. Serratia marcescens outbreak in a neonatal intensive care unit prompting review of decontamination of laryngoscopes. J Hosp Infect. 2005; 59: 68-70.

  23. Casolari C, Pecorari M, Fabio G. A simultaneous outbreak of Serratia marcescens and Klebsiella pneumoniae in a neonatal intensive care unit. J Hosp Infect. 2005; 61: 312-20.

  24. 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: 457-61.

  25. Ostrowsky BE, Whitener C, Bredenberg HK, et al. Serratia marcescens bacteremia traced to an infused narcotic. N Engl J Med. 2002; 346: 1529-37.

  26. Neal TJ, Corkill JE, Bennett KJ, Yoxall CW. Serratia marcescens pseudobacteraemia in neonates associated with a contaminated blood glucose/lactate analyzer confirmed by molecular typing. J Hosp Infect. 1999; 41: 219-22.

  27. Larson EL, Cimiotti JP, Haas J. Gram-negative bacilli associated with catheter-associated and non-catheter-associated bloodstream infections and hand carriage by healthcare workers in neonatal intensive care units. Pediatr Crit Care Med. 2005; 6: 457-61.

  28. Benjamin DK Jr., DeLong ER, Cotten CM, Garges HP, Clark RH. Postconception age and other risk factors associated with mortality following Gram-negative rod bacteremia. J Perinatol. 2004; 24: 169-74.

  29. Aygun C, Yigit S, Gur D. Serratia marcescens: an emerging microorganism in the neonatal intensive care unit. Turk J Pediatr. 2000; 42: 219-22.

  30. Zaidi N, Konstantinou K, Zervos M. The role of molecular biology and nucleic acid technology in the study of human infection and epidemiology. Arch Pathol Lab Med. 2003; 127: 1098-105.

  31. Hudome SM, Fisher MC. Nosocomial infections in the neonatal intensive care unit. Curr Opin Infect Dis. 2001; 14: 303-7.

  32. Lam BC, Lee J, Lau YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics. 2004; 114: e565-71.

  33. Won SP, Chou HC, Hsieh WS. Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2004; 25: 742-6.




2020     |     www.medigraphic.com