An Outbreak ofSerratia marcescensBloodstream Infections Associated With Misuse of Drug Vials in a Surgical Ward

Abstract

We report an outbreak of Serratia marcescens bloodstream infection due to contamination of total parenteral nutrition solution by insulin or poligeline solution when single-use vials were used for multiple doses in a surgical ward. Four patients had severe sepsis, and no patient died. Multidose vials, used either correctly or incorrectly, may be associated with bloodstream infection.

A Fatal Case of Infective Endocarditis Caused by an Unusual Suspect: <i>Serratia marcescens</i>

“…Recent data showed that all patient of infectious endocarditis due to S. marcescens survived though a combination of antibiotics and early surgical treatment (5). Serratia species has been occasionally recognized as the cause of healthcare-associated bacteremia due to the contamination of blood products (8), cleaning solutions (9), and inadequate sterile techniques with intravenous medication (10,11), however, a recent population-based study of Serratia species infection, including bacteremia in Canada, showed that 65% of infections were community-acquired infections (12) and similarly reports from Australia revealed that 47% of bacteremia episodes were started in the community (13). In the present case, bacteremia due to S. marcescens could have been caused by healthcare-associated infection during the first admission when she received intravenous fluid therapy.…”

An Outbreak of Serratia marcescens Sepsis in a Pediatric Ward

“…6 In the outbreak we describe, the mortality rate was 0.0%. We speculate that the reason for the absence of mortality was the prompt initiation of effective antibiotic therapy.…”

“…6 In the outbreak we describe, the possibility exists that hands contaminated with S marcescens may have contaminated the multidose drug bottles, syringes filled from a vial or the fluid tanks of the nebulizer.…”

An Outbreak of Klebsiella pneumoniae and Enterobacter aerogenes Bacteremia After Interventional Pain Management Procedures, New York City, 2008

“…The routine practice at the facility was to use vials designed for single patient use (containing no antibacterial preservative) for multiple patients. Multidose vials have previously been linked to bacterial infections involving contrast material, 10 saline, 7 polygeline or insulin, 11 and narcotics. 12,13 Similar medication use practices and lapses in infection control at other outpatient facilities in New York City and the United States have been linked to numerous outbreaks of hepatitis B and C. 14Y16 After meeting infection control recommendations, the facility was allowed to resume patient care.…”