J Korean Med Sci.  2006 Dec;21(6):973-978. 10.3346/jkms.2006.21.6.973.

Three-Year Follow-up of an Outbreak of Serratia marcescens Bacteriuria in a Neurosurgical Intensive Care Unit

• Kim BN
• Choi SI
• Ryoo NH

• KMID: 1713103
• DOI: http://doi.org/10.3346/jkms.2006.21.6.973

Abstract

We report on the investigations and interventions conducted to contain an extended outbreak of Serratia marcescens bacteriuria that lasted for years in a neurosurgical intensive care unit (NSICU). A case-control study was performed to identify the risk factors for S. marcescens acquisition in urine. In case patients, urine sampling for tests and central venous catheterization were performed more frequently before the isolation of S. marcescens. Case patients were more frequently prescribed third-generation cephalosporins. Adherence to hand antisepsis was encouraged through in-service educational meetings and infection control measures, especially concerning the manipulation of indwelling urinary catheters, were intensified. The outbreak persisted despite the reinforcement of infection control measures. However, no patient has newly acquired the organism in the NSICU since December 2004. Multiple factors, including inadequate infection control practices and inappropriate antimicrobial usage, possibly contributed to the persistence of this S. marcescens outbreak. Healthcare workers should consistently follow infection control policies to ensure quality care.

Keyword

Serratia marcescens; Bacteriuria; Disease Outbreaks; Infection Control

MeSH Terms

Serratia Infections/*epidemiology/*prevention & control/transmission
Risk Factors
Risk Assessment/*methods
Population Surveillance
Neurosurgery/*statistics & numerical data
Middle Aged
Male
Korea/epidemiology
Intensive Care Units/*statistics & numerical data
Infection Control/methods/statistics & numerical data
Incidence
Humans
Follow-Up Studies
Female
Disease Transmission, Horizontal/prevention & control/statistics & numerical data
Disease Outbreaks/prevention & control/statistics & numerical data
Case-Control Studies
Bacteriuria/*epidemiology/*prevention & control

Figure

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  Fig. 1 Distribution of patients who newly acquired Serratia marcescens in urine from July 1999 through February 2005.

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  Fig. 2 PFGE fingerprints of Serratia marcescens isolates. One major clone was shared by the isolates shown in lanes 1, 2, 4, and 5 (type A) with 2 closely-related isolates (lanes 3 and 6 designated as subtypes A1 and A2, respectively). Five isolates showed a different pattern (type B, lanes 7-11). Antimicrobial susceptibility patterns of the isolates above are shown according to clone type in Table 3. M, Lambda DNA size marker; C, control (E. coil O157: H7G5244).

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