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Consecutive Serratia marcescens multiclone outbreaks in a neonatal intensive care unit

2012; Elsevier BV; Volume: 40; Issue: 7 Linguagem: Inglês

10.1016/j.ajic.2011.08.019

1527-3296

Helena C. Maltezou, Kyriaki Tryfinopoulou, Panos Katerelos, Lemonia Ftika, Όλγα Παππά, Maria Tseroni, Evangelos Kostis, Christos Kostalos, Helen Prifti, Konstantina Tzanetou, Alkiviadis Vatopoulos,

Bacterial Identification and Susceptibility Testing

This report describes 3 consecutive outbreaks caused by genetically unrelated Serratia marcescens clones that occurred in a neonatal intensive care unit (NICU) over a 35-month period.Carriage testing in neonates and health care workers and environmental investigation were performed. An unmatched case-control study was conducted to identify risk factors for S marcescens isolation.During the 35-month period, there were 57 neonates with S marcescens isolation in the NICU, including 37 carriers and 20 infected neonates. The prevalence rate of S marcescens isolation was 12.3% in outbreak 1, 47.4% in outbreak 2, and 42% in outbreak 3. Nine of the 20 infected neonates died (45% case fatality rate). A total of 10 pulsed field gel electrophoresis types were introduced in the NICU in various times; 4 of these types accounted for the 9 fatal cases. During outbreak 3, a type VIII S marcescens strain, the prevalent clinical clone during this period, was detected in the milk kitchen sink drain. Multiple logistic regression revealed that the only statistically significant factor for S marcencens isolation was the administration of total parenteral nutrition.Total parenteral nutrition solution might constitute a possible route for the introduction of microorganisms in the NICU. Gaps in infection control should be identified and strict measures implemented to ensure patient safety.