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Investigation of a Nosocomial Outbreak Due to Serratia marcescens in a Maternity Hospital

  • Philippe Berthelot (a1), Florence Grattard (a2), Colette Amerger (a3), Marie-Claude Frery (a3), Frédéric Lucht (a1), Bruno Pozzetto (a2) and Philippe Fargier (a3)...

To investigate an outbreak of Serratia marcescens in a maternity hospital (November 1994 to May 1995).


Retrospective analysis of epidemiological data and prospective study of systematic bacteriological samples from patients and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction.


A private maternity hospital, Saint-Etienne, France.


In the neonatal unit, 1 newborn developed a bacteremia, and 36 were colonized in stools with S marcescens. As the colonization of some newborns was shown to occur only a few hours after delivery, the inquiry was extended to other maternity wards, where 8 babies and 4 mothers were found to be colonized. Environmental sampling led to the isolation of S marcescens from a bottle of enteral feed additive in the neonatal unit and from the transducers of two internal tocographs in the delivery rooms. The genotyping of 27 strains showed two different profiles: a major epidemic profile shared by 22 strains (18 from babies of the neonatal unit, 2 from babies of other units, and 2 from breast milk) and another profile shared by 5 strains (2 from transducers of internal tocographs, 2 from babies, and 1 from a mother). The strain isolated from lipid enteral feeding was not available for typing. Although this source of contamination was removed soon from the neonatal unit, the outbreak stopped only when infection control measures were reinforced in the delivery rooms, including the nonreuse of internal tocographs.


In delivery rooms, the quality of hygiene needs to be as high as in surgery rooms to prevent nosocomial colonization or infection of neonates at birth.

Corresponding author
Unité d'Hygiène, Hôpital Bellevue, CHU de Saint Etienne, 42055 Saint-Etienne Cedex 2, France
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1.Cimolai N, Trombley C, Wensley D, Leblanc J. Heterogeneous Serratia marcescens genotypes from a nosocomial pediatric outbreak. Chest 1997;111:194197.
2.McNaughton M, Mazinke N, Thomas E. Newborn conjunctivitis associated with triclosan 0.5% antiseptic intrinsically contaminated with Serratia marcescens. Canadian Journal of Infection Control 1995;10:78.
3.Christensen GD, Korones SB, Reed L, Bulley R, Laughlin B, Bisno AL. Epidemic Serratia marcescens in a neonatal intensive care unit: importance of the gastro-intestinal tract as a reservoir. Infect Control 1982;3:127131.
4.Grandsen WR, Webster M, French GL, Phillips I. An outbreak of Serratia marcescens transmitted by contaminated breast pumps in a special care baby unit J Hosp Infect 1986;7:149154.
5.Zaidi M, Sifuentes J, Bobadilla M, Moneada D, Ponce-de-Leon S. Epidemic of Serratia marcescens bacteremia and meningitidis in a neonatal unit in Mexico city. Infect Control Hosp Epidemiol 1989;10:1420.
6.Oie S, Kamiya A, Hironaga K, Koshiro A. Microbial contamination of enteral feeding solution and its prevention. Am J Infect Control 1993;21:3438.
7.Bosi C, Davin-Regli A, Charrel R, Rocca C, Monnet D, Boliet C. Serratia marcescens nosocomial outbreak due to contamination of hexetidine solution. J Hosp Infect 1996;33:217224.
8.Ghandi PA, Sawant AD, Wilson LA, Ahearn DG. Adaptation and growth of Serratia marcescens in contact lens disinfectant solutions containing Chlorhexidine gluconate. Appi Environ Microbiol 1993;59:183188.
9.Cétre JC, Baratto D, Tissot-Guerraz F, Nicolle MC, Reverdy E, Parvaz P, et al. Septicémies nosocomiales et pseudo-bactériémies à Serratia marcescens. Presse Med 1988;17:12551258.
10.Miranda G, Kelly C, Solorzano F, Léanos C, Coria R, Patterson JE. Use of pulsed field gel electrophoresis typing to study an outbreak of infection due to Serratia marcescens in a neonatal intensive care unit. J Clin Microbiol 1996;34:31383141.
11.Gaynes RP, Edwards JR, Jarvis WR, Culver DH, Toison JS, Martone WJ, et al. Nosocomial infections among neonates in high-risk nurseries in the United States. Pediatrics 1996;98:357361.
12.Grattard F, Berthelot P, Reyrolle M, Ros A, Etienne J, Pozzetto C. Molecular typing of nosocomial strains of Legionella pneumophila by arbitrarily primed PCR J Clin Microbiol 1996;34:15951598.
13.Grattard F, Pozzetto C, Tabard L, Petit M, Ros A, Gaudin OG. Characterization of nosocomial strains of Enterobacter aerogenes by arbitrarily primed-PCR analysis and ribotyping. Infect Control Hosp Epidemiol 1995;16:224230.
14.Passaro DJ, Waring L, Armstrong R, Bolding F, Bouvier C, Rosenberg J, et al. Postoperative Serratia marcescens wound infections traced to an out-of-hospital source. J Infect Dis 1997;175:992995.
15.Stephen M, Lalitha MKAn outbreak of Serratia marcescens infection among obstetric patients. Indian J Med Res 1993;97:202205.
16.Vandebroucke-Grauls CM, Baars AC, Visser MR, Hulstet PF, Verhoef J. An outbreak of Serratia marcescens traced to a contaminated bronchoscope. J Hosp Infect 1993;23:263270.
17.Kühn I, Ayling-Smith B, Tullus K, Burman LG. The use of colonization rate and epidemic index as tools to illustrate the epidemiology of faecal Enterobacteriaceae strains in Swedish neonatal wards. J Hosp Infect 1993;23:287297.
18.Fujita K, Murono K, Nosocomial acquisition of Escherichia coli by infants delivered in hospitals. J Hosp Infect 1996;32:277281.
19.Braver DJ, Hauser GJ, Berns L, Siegman-Igra Y, Muhlbauer C. Control of a Serratia marcescens outbreak in a maternity hospital. J Hosp Infect 1987;10:129137.
20.Chia YT, Arulkumaran S, Soon SB, Norshida S, Ratnam SS. Induction of labour: does internal tocography result in better obstetric outcome than external tocography? Aust NZJ Obstet Gynaecol 1993;33:159161.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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