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Outbreak of Serratia marcescens Colonization and Infection Traced to a Healthcare Worker With Long-Term Carriage on the Hands

  • Jutte J. C. de Vries (a1), Willy H. Baas (a1), Kees van der Ploeg (a2), Albêrt Heesink (a3), John E. Degener (a1) and Jan P. Arends (a1)...
Abstract
Objective.

To reveal the source of a nosocomial outbreak of colonization and infection with a strain of Serratia marcescens positive for Guiana extended-spectrum β-lactamase 1 (GES-1) that occurred among patients in a neurosurgical intensive care unit (ICU) in a Dutch university medical center from May 2002 through March 2003.

Methods.

Samples from the environment and from the hands of healthcare workers (HCWs) were cultured. A retrospective case-control study was carried out.

Results.

Fifteen neurosurgical ICU patients who had 1 or more cultures that yielded the epidemic strain of S. marcescens from May 2002 through March 2003 were defined as case patients and matched with 30 control patients. Environmental cultures did not reveal a prominent source of S. marcescens. Cultures of specimens from the hands of 100 HCWs revealed colonization of a single HCW with the epidemic strain. Although this HCW instantly went on leave, serial cultures detected prolonged carriage of the epidemic strain on the hands of the HCW for 3 months. The skin of the HCW's hands was psoriatic. The epidemic abruptly ended after the colonized HCW went on leave. Retrospective case-control analysis showed that the patients colonized or infected with S. marcescens received significantly more nursing care from the colonized HCW than did control patients (P<.05). From February 2004 through October 2004, a second cluster of 3 patients was detected with the epidemic strain of S. marcescens. In October 2004, the formerly colonized HCW appeared to have carriage of the epidemic strain on the hands again.

Conclusions.

A single HCW with the epidemic strain of S. marcescens on the hands was considered the source of this outbreak.

Copyright
Corresponding author
Department of Medical Microbiology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands (j.j.c.de.vries@mmb.umcg.nl)
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1. WH Dodson . Serratia marcescens septicemia. Arch Intern Med 1968; 121:145150.

2. JN Wilfert , FF Barrett , EH Kass . Bacteremia due to Serratia marcescens. N Engl J Med 1968; 279:286289.

3. VL Yu . Serratia marcescens: historical perspective and clinical review. N Engl J Med 1979; 300:887893.

4. RA Weinstein . Nosocomial infection update. Emerg Infect Dis 1998; 4:416420.

7. LA Grohskopf , VR Roth , DR Feikin , et al. Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center. N Engl J Med 2001; 344:14911497.

8. BE Ostrowsky , C Whitener , HK Bredenberg , et al. Serratia marcescens bacteremia traced to an infused narcotic. N Engl J Med 2002; 346:15291537.

9. DJ Passaro , L Waring , R Armstrong , et al. Postoperative Serratia marcescens wound infections traced to an out-of-hospital source. J Infect Dis 1997; 175:992995.

11. SJ Sokalski , MA Jewell , AC Asmus-Shillington , J Mulcahy , J Segreti . An outbreak of Serratia marcescens in 14 adult cardiac surgical patients associated with 2-lead electrocardiogram bulbs. Arch Intern Med 1992; 152:841844.

12. ER van der Vorm , C Woldring-Zwaan . Source, carriers, and management of a Serratia marcescens outbreak on a pulmonary unit. J Hosp Infect 2002; 52:263267.

13. ML van Ogtrop , D Zoeren-Grobben , EM Verbakel-Salomons , CP van Boven . Serratia marcescens infections in neonatal departments: description of an outbreak and review of the literature. J Hosp Infect 1997; 36:95103.

14. CM Vandenbroucke-Grauls , AC Baars , MR Visser , PF Hulstaert , J Verhoef . An outbreak of Serratia marcescens traced to a contaminated bronchoscope. J Hosp Infect 1993; 23:263270.

17. A Hejazi , HM Aucken , FR Falkiner . Epidemiology and susceptibility of Serratia marcescens in a large general hospital over an 8-year period. J Hosp Infect 2000; 45:4246.

18. TN Jang , CP Fung , TL Yang , SH Shen , CS Huang , SH Lee . Use of pulsed-field gel electrophoresis to investigate an outbreak of Serratia marcescens infection in a neonatal intensive care unit. J Hosp Infect 2001; 48:1319.

19. DR Schaberg , RH Alford , R Anderson , JJ Farmer III, MA Melly , W Schaffner . An outbreak of nosocomial infection due to multiply resistant Serratia marcescens: evidence of interhospital spread. J Infect Dis 1976; 134:181188.

20. Brugge van der Sar-van der , SM Arend , AT Bernards , et al. Risk factors for acquisition of Serratia marcescens in a surgical intensive care unit. J Hosp Infect 1999; 41:291299.

21. JE Degener , I Phillips . Comparison of antimicrobial susceptibility test breakpoints of national societies. Clin Microbiol Infect 2001; 7:5154.

22. AM Snelling , PM Hawkey , J Heritage , P Downey , PM Bennett , B Holmes . The use of a DNA probe and PCR to examine the distribution of the aac(6')-Ic gene in Serratia marcescens and other gram-negative bacteria. J Antimicrob Chemother 1993; 31:841854.

23. L Poirel , I Le Thomas , T Naas , A Karim , P Nordmann . Biochemical sequence analyses of GES-1, a novel class A extended-spectrum beta-lactamase, and the class 1 integron In52 from Klebsiella pneumoniae. Antimicrob Agents Chemother 2000; 44:622632.

26. J Dave , S Reith , JQ Nash , RR Marples , C Dulake . A double outbreak of exfoliative toxin-producing strains of Staphylococcus aureus in a maternity unit. Epidemiol Infect 1994; 112:103114.

27. TD Mastro , TA Farley , JA Elliott , et al. An outbreak of surgical-wound infections due to group A Streptococcus carried on the scalp. N Engl J Med 1990; 323:968972.

28. KJ Mutton , LM Brady , JL Harkness . Serratia cross-infection in an intensive therapy unit. J Hosp Infect 1981; 2:8591.

29. M Foca , K Jakob , S Whittier , et al. Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. N Engl J Med 2000; 343:695700.

30. EL Larson , CA Hughes , JD Pyrek , SM Sparks , EU Cagatay , JM Bartkus . Changes in bacterial flora associated with skin damage on hands of health care personnel. Am J Infect Control 1998; 26:513521.

32. AE Buxton , RL Anderson , D Werdegar , E Atlas . Nosocomial respiratory tract infection and colonization with Acinetobacter calcoaceticus: epidemiologic characteristics. Am J Med 1978; 65:507513.

33. AF Widmer , RP Wenzel , A Trilla , MJ Bale , RN Jones , BN Doebbeling . Outbreak of Pseudomonas aeruginosa infections in a surgical intensive care unit: probable transmission via hands of a health care worker. Clin Infect Dis 1993; 16:372376.

34. JP Burke , D Ingall , JO Klein , HM Gezon , M Finland . Proteus mirabilis infections in a hospital nursery traced to a human carrier. N Engl J Med 1971;284:115121.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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