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Outbreak of Multidrug-Resistant Serratia marcescens Infection in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Lisa L. Maragakis ,
Amy Winkler ,
Margaret G. Tucker ,
Sara E. Cosgrove ,
Tracy Ross ,
Edward Lawson ,
Karen C. Carroll  and
Trish M. Perl
Lisa L. Maragakis*
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Amy Winkler
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Margaret G. Tucker
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Sara E. Cosgrove
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Tracy Ross
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Edward Lawson
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Karen C. Carroll
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
Trish M. Perl
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
*
Department of Hospital Epidemiology and Infection Control, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Osier 425, Baltimore, MD 21287, (lmaraga1@jhmi.edu)
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Abstract

Background.

Serratia marcescens causes healthcare-associated infections and significant morbidity and mortality in neonatal intensive care units (NICUs). We report the investigation and control of an outbreak of multidrug-resistant (MDR) S. marcescens infection at an NICU.

Methods.

An outbreak investigation and a case-control study were undertaken at a 36-bed NICU in a tertiary care hospital in Baltimore, Maryland, for the period from October 2004 through February 2005. The outbreak investigation included case identification, review of medical records, environmental cultures, patient surveillance cultures, personnel hand cultures, and pulsed-field gel electrophoresis (PFGE). The case-control study included case identification and review of medical records. Infection control measures were implemented. Eighteen NICU neonates had cultures that grew MDR S. marcescens during the study period. The case-control study included 16 patients with the outbreak strain or an unidentified strain of MDR S. marcescens and 32 control patients not infected and/or colonized with MDR S. marcescens, treated in the NICU for at least 48 hours during the study period.

Results.

PFGE analysis identified a single strain of MDR S. marcescens that infected or colonized 15 patients. Two patients had unique strains, and 1 patient's isolate could not be subtyped. An unrelated MDR S. marcescens isolate was recovered from a sink drain. Exposure to inhalational therapy was an independent risk factor for MDR S. marcescens acquisition after adjusting for birth weight. Extensive investigation failed to reveal a point source for the outbreak.

Conclusion.

A single epidemic strain of MDR S. marcescens spread rapidly and threatened to become endemic in this NICU. Transient carriage on the hands of healthcare personnel or on respiratory care equipment was the likely mode of transmission. Cohorting patients and staff, at the cost of bed closures and additional personnel, interrupted transmission and halted the outbreak.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 5 , May 2008 , pp. 418 - 423
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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