A simultaneous outbreak of Serratia marcescens and Klebsiella pneumoniae in a neonatal intensive care unit

Casolari, Chiara; Pecorari, Monica; Fabio, Giuliana; Cattani, Silvia; Venturelli, Claudia; Piccinini, L; Tamassia, Maria Grazia; Gennari, William; Sabbatini, Anna Maria Teresa; Leporati, G.; Marchegiano, Patrizia; Rumpianesi, Fabio; Ferrari, Fabrizio

doi:10.1016/j.jhin.2005.03.005

Cited by 62 publications

(44 citation statements)

References 41 publications

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“…Here, the mean age of the patients in the clinical area of the H1 hospital was 53 years, a bit higher than what is found in the literature (32)(33)(34)(35). Although an environmental source, mainly hospital settings and fomites, has been found in some outbreaks (13,36), most of these events were characterized by the lack of a detectable cause (2,34). In this study, environmental reservoirs of S. marcescens in the clinical medicine area were not found, probably due to the delay in collecting samples after case onset (six months, from November 2007 to April 2008).…”

Section: Discussioncontrasting

confidence: 65%

“…S. marcescens is a well-recognized cause of hospital-acquired infection during the three last decades, mainly in areas of risk and immunocompromised patients. Several outbreaks, more commonly in neonatal units than in adults, have been documented and were associated with a single cluster (32,33) as well as with the combination of two or more clusters (3,34). Here, the mean age of the patients in the clinical area of the H1 hospital was 53 years, a bit higher than what is found in the literature (32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 54%

“…Several outbreaks, more commonly in neonatal units than in adults, have been documented and were associated with a single cluster (32,33) as well as with the combination of two or more clusters (3,34). Here, the mean age of the patients in the clinical area of the H1 hospital was 53 years, a bit higher than what is found in the literature (32)(33)(34)(35). Although an environmental source, mainly hospital settings and fomites, has been found in some outbreaks (13,36), most of these events were characterized by the lack of a detectable cause (2,34).…”

Section: Discussionmentioning

confidence: 99%

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Outbreak of a Cluster with Epidemic Behavior Due to Serratia marcescens after Colistin Administration in a Hospital Setting

et al. 2013

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dSerratia marcescens causes health care-associated infections with important morbidity and mortality. Particularly, outbreaks produced by multidrug-resistant isolates of this species, which is already naturally resistant to several antibiotics, including colistin, are usually described with high rates of fatal outcomes throughout the world. Thus, it is important to survey factors associated with increasing frequency and/or emergence of multidrug-resistant S. marcescens nosocomial infections. We report the investigation and control of an outbreak with 40% mortality due to multidrug-resistant S. marcescens infections that happened from November 2007 to April 2008 after treatment with colistin for Acinetobacter baumannii meningitis was started at hospital H1 in 2005. Since that year, the epidemiological pattern of frequently recovered species has changed, with an increase of S. marcescens and Proteus mirabilis infections in 2006 in concordance with a significant decrease of the numbers of P. aeruginosa and A. baumannii isolates. A single pulsed-field gel electrophoresis (PFGE) cluster of S. marcescens isolates was identified during the outbreak. When this cluster was compared with S. marcescens strains (n ‫؍‬ 21) from 10 other hospitals (1997 to 2010), it was also identified in both sporadic and outbreak isolates circulating in 4 hospitals in Argentina. In132::ISCR1::bla CTX-M-2 was associated with the multidrug-resistant cluster with epidemic behavior when isolated from outbreaks. Standard infection control interventions interrupted transmission of this cluster even when treatment with colistin continued in several wards of hospital H1 until now. Optimizing use of colistin should be achieved simultaneously with improved infection control to prevent the emergence of species naturally resistant to colistin, such as S. marcescens and P. mirabilis.

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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Outbreak of a Cluster with Epidemic Behavior Due to Serratia marcescens after Colistin Administration in a Hospital Setting

et al. 2013

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“…"Indistinguishable" was defined as Ͼ97% similarity and no banding differences, including no variation in the intensities of individual bands, although overall intensities may differ. S. marcescens is recognized as a heterogeneous species that probably contains an unlimited number of different clones (3). PFGE fingerprinting.…”

Section: Methodsmentioning

confidence: 99%

Comparative Evaluation of an Automated Repetitive-Sequence-Based PCR Instrument versus Pulsed-Field Gel Electrophoresis in the Setting of a Serratia marcescens Nosocomial Infection Outbreak

et al. 2010

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A semiautomated, repetitive-sequence-based PCR (rep-PCR) instrument (DiversiLab system) was evaluated in comparison with pulsed-field gel electrophoresis (PFGE) to investigate an outbreak of Serratia marcescens infections in a neonatal intensive care unit (NICU). A selection of 36 epidemiologically related and 8 epidemiologically unrelated isolates was analyzed. Among the epidemiologically related isolates, PFGE identified five genetically unrelated patterns. Thirty-two isolates from patients and wet nurses showed the same PFGE profile (pattern A). Genetically unrelated PFGE patterns were found in one patient (pattern B), in two wet nurses (patterns C and D), and in an environmental isolate from the NICU (pattern G). Rep-PCR identified seven different patterns, three of which included the 32 isolates of PFGE type A. One or two band differences in isolates of these three types allowed isolates to be categorized as similar and included in a unique cluster. Isolates of different PFGE types were also of unrelated rep-PCR types. All of the epidemiologically unrelated isolates were of different PFGE and rep-PCR types. The level of discrimination exhibited by rep-PCR with the DiversiLab system allowed us to conclude that this method was able to identify genetic similarity in a spatio-temporal cluster of S. marcescens isolates.Concerns regarding the emergence of hospital-acquired infections, increasing antimicrobial resistance, and the increase in morbidity, mortality, and costs associated with these infections drive the need for refinement of molecular approaches to aid in the diagnosis and epidemiological analysis of nosocomial infections.Several methods based on DNA analysis are now available that provide information about the genetic relatedness of isolates of the same species (26). These DNA-based molecular methodologies include pulsed-field gel electrophoresis (PFGE), PCR-based typing methods, and multilocus sequence analysis.

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“…While the medical significance of Klebsiella obtained in the natural environment is far from clear, such habitats are thought to be potential reservoirs for the growth and spread of these bacteria which may colonize animals and humans (Knittel et al, 1977). Of the five identified Klebsiella species, K. oxytoca and K. Pneumonia, remain the most clinically important opportunistic pathogen, implicated in communityacquired pyogenic liver abscess and bacterial meningitis in adults (Casolari et al, 2005;Haryani et al, 2007;Keynan and Rubinstein, 2007), has been reported to be present in water (Syposs et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Detection of Bacterial Pathogens in River Water Using Multiplex-PCR

Kinge¹,

Mbewe²,

Sithebe³

2012

Polymerase Chain Reaction

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A simultaneous outbreak of Serratia marcescens and Klebsiella pneumoniae in a neonatal intensive care unit

Cited by 62 publications

References 41 publications

Outbreak of a Cluster with Epidemic Behavior Due to Serratia marcescens after Colistin Administration in a Hospital Setting

Outbreak of a Cluster with Epidemic Behavior Due to Serratia marcescens after Colistin Administration in a Hospital Setting

Comparative Evaluation of an Automated Repetitive-Sequence-Based PCR Instrument versus Pulsed-Field Gel Electrophoresis in the Setting of a Serratia marcescens Nosocomial Infection Outbreak

Detection of Bacterial Pathogens in River Water Using Multiplex-PCR

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