Serratia MarcescensMeningitis Associated With a Contaminated Benzalkonium Chloride Solution

Abstract

Serratia marcescens is recognized as an important and potentially hazardous nosocomial pathogen. The organism has been implicated here as the first reported case of S. marcescens meningitis associated with skin disinfection. A quaternary ammonium compound (QAC—Benzalkonium Chloride), was used to sterilize the skin prior to injection in a physician's office. Epidemiological studies were initiated. Six spray bottles containing disinfectant, the opened stock bottle of QAC, and an unopened bottle of disinfectant were all cultured. S. marcescens was noted growing in the spray bottles as well as in the opened stock bottle. Anti-biograms of the patient and epidemiological isolates are essentially the same. It is our contention as well as that of the Centers for Disease Control that an appropriate skin disinfectant such as Tincture of Chlorhexidine, Iodophors, or Tincture of Iodine should be used, and that physicians performing surgical techniques in the office be aware of the potential hazard of contamination. The consequences of nosocomial infection with resistant organisms warrant every precaution by health care professionals.

An outbreak of multidrug-resistant Serratia marcescens: the importance of continuous monitoring of nosocomial infections

“…Halaby et al (17) reported a case of fatal bacterial meningitis after spinal anesthesia. Several studies described infections caused by Serratia marcescens associated with contaminated disinfectants and antiseptics (5,6,(18)(19)(20). Sauter et al (6) reported a case of meningitis associated with contamination of a skin antiseptic solution containing benzalkonium chloride.…”

“…Outbreaks have been traced to multiple sources, including contaminated solutions and disinfectants, intravenous fluids, mechanical respirators, intravenous catheters, ultrasonic nebulizers, fiberoptic bronchoscopes, and hand-to-hand transmission by hospital personnel (4)(5)(6)(7).…”

Hand Hygiene

“…Unfortunately, because of weak activity against Gram-negative bacteria, benzalkonium chloride is prone to contamination by these organisms and a number of outbreaks of infection or pseudoinfection have been traced to QACs contaminated with Gramnegative bacilli. [386][387][388] For this reason, these compounds have seldom been used for hand antisepsis during the last 15-20 years in the USA. More recently, newer hand hygiene products containing benzalkonium chloride or benzethonium chloride have been introduced for use by HCWs.…”

<i>Serratia marcescens</i> as Opportunistic Pathogen and the Importance of Continuous Monitoring of Nosocomial Infection in Makah City, Saudi Arabia

“…Infections caused by this organism have been reported with increasing frequency since 1960 [5]. Serratia marcescens has expressed the ability to survive and grow under extreme conditions, including in disinfectants, antiseptics and double-distilled water [6]. Serratia can be easily spread in the nosocomial environment and contaminate medical equipment, instruments, commercial fluids, disinfectants and dispensers [1].…”