Outbreak investigation of Serratia marcescens neurosurgical site infections associated with a contaminated shaving razors

Abstract

Background: Surgical site infection (SSI) is the most common healthcare-associated infection. We report an outbreak of neurosurgical site infections caused by Serratia marcescens after craniotomy in a tertiary care hospital. Methods: Between August 6 and 21, 2018, five cases of early-onset SSI caused by S. marcescens after craniotomy were recorded in a 1786-bed tertiary care hospital. Cultures were collected from potential environmental sources and healthcare workers. Whole-genome sequencing (WGS) was used to investigate the genetic relationships among S. marcescens isolates. Results: The outbreak involved five patients; S. marcescens was isolated from the cerebrospinal fluid, pus, tissue, and blood samples from these patients. S. marcescens was also isolated from shaving razors and brushes. All S. marcescens isolates from the infected patients and razors showed the same resistance patterns on antibioticsusceptibility tests. WGS revealed close clustering among four of five isolates from the patients and among three of four isolates from the razors. No additional patient developed S. marcescens infection after we stopped using the razors for scalp shaving. Conclusions: We report an outbreak of neurosurgical site infections after craniotomy, which was associated with shaving razors contaminated by S. marcescens. Shaving scalps with razors should be avoided to prevent SSI.

Contribution of the patient microbiome to surgical site infection and antibiotic prophylaxis failure in spine surgery

“…This aspect of our study is unique in that it captures the molecular epidemiology of SSI among all patients in a high-risk procedural group undergoing surgery within a shared environment during routine operating conditions. Although case reports of common source SSI continue to draw attention to important avenues of nosocomial transmission (47,48), our findings suggest that such events are unlikely to be representative of the factors and modes of transmission most commonly contributing to SSI. Thus, whereas efforts to identify and disrupt environmental reservoirs of infection within the hospital remain critical to maintaining progress in SSI prevention, future innovations targeting residual patient microbiota are expected to have greater potential for achieving further improvements.…”

Serratia marcescens Endocarditis in Prosthetic Valves

“…Case reports describing Serratia outbreaks from bronchoscopes, contaminated chloroxylenol soap, surgical razors, contaminated respirators/nebulizer machines, stethoscopes, vials, and other fomites have been extensively described in the literature [5][6][7][8][9][10][11][12][13]. Invasive procedures such as surgery (arthrocentesis), use of contaminated vials, use of single-use medication vials on multiple patients, use of a common syringe for multiple medications/patients, and use of multidose vials have been associated with outbreaks of nosocomial infections.…”

Antibiotic Sensitivity Pattern of Serratia Species from Clinical Samples at a Tertiary Care Hospital in Rawalpindi

“…Outbreaks of Wound infections particularly post operative surgical site infections have also been mentioned in literature. 19 Serratia marscenes is also an etiology of Bacteremia, Sepsis and Urinary Tract infections. In our present write up during outbreak years Serratia specie were most commonly obtained from Blood cultures.…”