Infection with netilmicin resistant Serratia marcescens in a special care baby unit (original) (raw)
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Three Consecutive Outbreaks of Serratia marcescens in a Neonatal Intensive Care Unit
Clinical Infectious Diseases, 2002
We investigated an outbreak of Serratia marcescens in the neonatal intensive care unit (NICU) of the University Hospital of Zurich. S. marcescens infection was detected in 4 children transferred from the NICU to the University Children's Hospital (Zurich). All isolates showed identical banding patterns by pulsed-field gel electrophoresis (PFGE). In a prevalence survey, 11 of 20 neonates were found to be colonized. S. marcescens was isolated from bottles of liquid theophylline. Despite replacement of these bottles, S. marcescens colonization was detected in additional patients. Prospective collection of stool and gastric aspirate specimens revealed that colonization occurred in some babies within 24 hours after delivery. These isolates showed a different genotype. Cultures of milk from used milk bottles yielded S. marcescens. These isolates showed a third genotype. The method of reprocessing bottles was changed to thermal disinfection. In follow-up prevalence studies, 0 of 29 neonates were found to be colonized by S. marcescens. In summary, 3 consecutive outbreaks caused by 3 genetically unrelated clones of S. marcescens could be documented. Contaminated milk could be identified as the source of at least the third outbreak.
International Journal of Hygiene and Environmental Health, 2010
The following recommendations are derived from a systematic analysis of 34 Serratia marcescens outbreaks described in 27 publications from neonatal and pediatric intensive care units (NICU, PICU), in which genotyping methods were used to confirm or exclude clonality. The clinical observation of two or more temporally related cases of nosocomial S. marcescens infection should raise the suspicion of an outbreak, particularly in the NICU or PICU setting. Since colonized or infected patients represent the most important reservoir for cross transmission, hygienic barrier precautions (contact isolation/cohortation, the use of gloves and gowns in addition to strictly performed hand disinfection, enhanced environmental disinfection) should immediately be implemented and staff education given. Well-planned sampling of potential environmental sources should only be performed when these supervised barrier precautions do not result in containment of the outbreak. The current strategy of empiric antibiotic treatment should be reevaluated by a medical microbiologist or an infectious disease specialist. Empiric treatment of colonized children should use combination therapy informed by in vitro susceptibility data; in this context the high propensity of S. marcescens to cause meningitis and intracerebral abscess formation should be considered. In vitro susceptibility patterns do not reliably prove or exclude the clonality of the outbreak isolate. Genotyping of the isolates by pulse-field gel electrophoresis or PCR-based methods should be performed, but any interventions to interrupt further nosocomial spread should be carried out without waiting for the results.
An Outbreak of Serratia marcescens in a Moroccan Neonatal Intensive Care Unit
Advances in Medicine, 2018
Serratia marcescens (S. marcescens) is an Enterobacteriaceae microorganism that is widespread in the environment, which may be the source of nosocomial infections, rare in the newborn but severe, and often in the form of outbreaks. e aim of our study is to report our experience, during an outbreak of S. marcescens, to show the severity of this germ, with review of the literature. Our study was retrospective, including 8 newborns with S. marcescens nosocomial infection, collected in the neonatal intensive care unit of Mohammed VI University Medical Hospital, during the epidemic period, over a period of 2 months (July and August 2016). e mean gestational age of the cases was 36 weeks of amenorrhea. Boys accounted for 75% of the cases. e average weight was 1853 grams. All the patients were initially placed under empiric antibiotic therapy based on ceftriaxone and gentamicin. e mean duration of nosocomial infection, diagnosed in all cases by blood cultures, was 7 days. e strains of S. marcescens were in 75% of the cases sensitive to the cephalosporins, intermediate sensitivity in 12.5% of cases and resistant in 12.5% of cases. e outcome was fatal in 62.5% of cases. S. marcescens nosocomial infections are often reported on epidemic series, and their eradication is not always easy.
Serratia Marcescensbacteraemia in Preterm Neonate - a Case Report
Zenodo (CERN European Organization for Nuclear Research), 2023
Background: Serratia marcescens has emerged as opportunist in increasing number of hospital-associated infections in neonatal intensive care unit (NICUs), particularly as bloodstream infections. It is known to cause outbreaks in the NICUs, with high mortality rate in th e vulnerable preterm population. Case presentation: We present a case of one and half month-old preterm neonate who had complaints of in t o lerance t o f eedin g a nd failure to thrive. Clinical investigation revealed anaemia and increased inflammatory markers. Blood culture showed growth of S marcescens. In antimicrobial susceptibility testing, the isolate showed susceptibilit y to all β-lactams, aminoglycosides and sulfamethoxazole-trimethoprim, but treatment failure occurred with empirical amikacin and piperacillintazobactam. Institution of meropenem showed good response. Discussion: In premature babies with very low birth weight along wit h prolonged NICU stay predisposed them to S marcescens infection. Th e capacity of S marcescens to resist antibiotic therapy in vivo in sp it e o f the in vitro sensitivity was exemplified in our case. Conclusion: This case study portrays the important feature of S marcescens to develop 'in-vivo' resistance despite being sen sit iv e b y 'in vitro' testing which led to therapeutic failure. Carbapenem could be a choice in such treatment failure cases due S marcescens.
Serratia marcescens Isolated in 2005 From Clinical Specimens From Patients With Diminished Immunity
Transplantation Proceedings, 2007
Serratia marcescens is an important agent in hospital infections. The aim of this paper was to compare the resistance patterns of S. marcescens strains isolated during 1 year from patients of various wards of the Institute of Transplantology. The mechanisms of beta-lactam antibiotic resistance were of especial interest. We investigated the 81 strains of S. marcescens, isolated during 2005 from patients on 3 wards and 1 clinic of the Transplantation Institute. An unusually high resistance to most antibiotics was observed among S. marcescens strains. Extended spectrum beta-lactamases (ESBLs) were probably produced by 63.2% to 84.6% of strains, depending on the ward. Additionally, about 30% of them were probably derepressed AmpC producers. The patterns of resistance indicated that at least 2 resistant clones of S. marcescens spread among the patients. One of the clones demonstrated both ESBL and derepressed AmpC production and was susceptible only to carbapenems. The second, producing ESBL, was susceptible to pipercillin/ tazobactam and carbapenems. All investigated strains were resistant to nitrofurantoin. Strains of the second group were rarely susceptible to other antibiotics: aminoglycosides, ciprofloxacin, cotrimoxazole, or fosfomycin.
American Journal of Infection Control, 2008
Background: In March 2004, infection or colonization with Serratia marcescens affected one third of all neonates in a newborn services unit (NBS). Methods: We performed a case-control study and automated ribotyping. Results: Forty-nine cases were compared with 64 controls. The overall mean length of stay (LOS) in the NBS was 67 days for cases and 36 days for controls, P 5 .005. Cases were of lower mean birth weight than controls (1566 g vs 1968 g, respectively, P 5 .02). Risk factors that trended toward significance for S marcescens acquisition included the following: premature rupture of membranes (odds ratio [OR], 2.7; 95% confidence interval [95% CI]: 1.0-7.1; P 5 .05), vaginal delivery at our hospital (OR, 2.1; 95% CI: 0.9-4.6; P 5 .06), intubation at delivery (OR, 2.3; 95% CI: 0.9-5.2; P 5 .05), mechanical ventilation (OR, 2.1; 95% CI: 0.9-4.4; P 5 .06), and theophylline treatment (OR, 2.5; 95% CI: 1.1-5.4; P 5 .02). Multiple logistic regression analysis revealed vaginal delivery at our hospital (OR, 3.4; 95% CI: 1.4-8.2; P 5 .007) and LOS .30 days (OR, 4.4; 95% CI: 1.8-10.6; P 5 .001) as independent risk factors for S marcescens acquisition. Ribotyping of specimens revealed 5 restriction patterns. Conclusion: Cases were of lower birth weight than controls, were born by vaginal delivery at our hospital, had longer LOS in NBS, and had greater requirements for respiratory support. Ribotyping of specimens revealed that this outbreak was not clonal. (Am J Infect Control 2008;36:22-8.)
Investigation of an outbreak of Serratia marcescens in a neonatal intensive care unit
Journal of Microbiology Immunology and Infection, 2011
Neonatal intensive care unit; Pulsed-field gel electrophoresis (PFGE); Serratia marcescens Background: Serratia marcescens is a well-known but relatively uncommon cause of nosocomial infections, particularly in neonatal intensive care unit (NICU) patients. We investigated an outbreak of S marcescens in the NICU at the Farabi Hospital of Karadeniz Technical University in Trabzon, Turkey. Methods: Between March 21 and May 27, 2006, nine of the neonates were identified with cultures of S marcescens, and there were three deaths because of septicemia. For the purpose of identifying the source of infection, 85 environmental samples, two breast milk samples from two babies' mothers, and 38 hand-washing samples from the health care workers (HCWs) were collected for the detection of S marcescens. All the S marcescens isolates were genotyped by pulsed-field gel electrophoresis with endonuclease SpeI restriction enzyme. Results: Serratia marcescens was identified from one hand-washing sample and two breast milk samples. None of the environmental samples yielded S marcescens. Of the 13 isolates analyzed, four belonged to one major genotype, whereas eight (6 from neonates and 2 from breast milk) were indistinguishable; two isolates (2 from neonates) were closely related; and three isolates (2 other neonates and 1 from HCW's hand) were different. Our intensive efforts failed to determine the source of the outbreak despite the finding that S marcescens strain was isolated from a HCW's hand. Conclusion: Present investigation suggested that an outbreak of S marcescens infection was caused by a major clone in our NICU, possibly transmitted through the hands of HCWs,
An outbreak of Serratia marcescens septicemia in neonates
Indian Pediatrics, 2009
Serratia marcescens is a well recognized nosocomial pathogen. We report an outbreak with this organism in 8 neonates in a neonatal intensive care unit (NICU). Seven cases were treated successfully with meropenem after the failure of imipenem treatment. Although they have similar anti-microbial effects, meropenem can effectively treat the S. marcescens sepsis resistant to imipenem.