Epidemiological and bacteriological investigation of<i>Serratia marcescens</i>epidemic in a nursery and in a neonatal intensive care unit

Montanaro, Donatella; Grasso, G.; Annino, I.; Ruggiero, N. de; Scarcella, A; Schioppa, F

doi:10.1017/s0022172400060940

Cited by 22 publications

(13 citation statements)

References 28 publications

(24 reference statements)

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“…Outbreaks of Serratia marcescens are well documented, particularly outbreaks in neonatal units (14,16,27,31). One reported outbreak was caused by netilmicin-resistant S. marcescens shortly after netilmicin had been introduced as the primary aminoglycoside (16).…”

Section: Discussionmentioning

confidence: 99%

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Increased resistance to amikacin in a neonatal unit following intensive amikacin usage

Friedland

Funk

Khoosal

et al. 1992

Antimicrob Agents Chemother

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Gram-negative isolates from blood and cerebrospinal fluid were monitored for 1 year before and for 1 year after the first-line aminoglycoside in a busy pediatric department was changed from gentamicin to amikacin.In the general pediatric wards, the switch to amikacin resulted in no change in resistance of nosocomial gram-negative infections to either amikacin (0%Yo before and after) or gentamicin (23.9% [before] versus 26.5% [after]). In the neonatal unit, the switch to amikacin was followed by an outbreak of Serratia spp. that were commonly resistant to amikacin but susceptible to gentamicin. This outbreak abated spontaneously. In the year after the change in aminoglycoside usage, the resistance to amikacin of nosocomially acquired gram-negative infections increased from 7.6 to 27.7% (P < 0.001), and the resistance to gentamicin decreased from 71.2 to 60.2% (P = 0.07). The increase in amikacin resistance of gram-negative bacilli other than Serratia spp. has persisted for more than a year after the introduction of amikacin as the sole aminoglycoside. The different effects observed in the two sections of the pediatric department may be related to the more intensive usage of aminoglycosides in the neonatal unit.The effect of predominant amikacin usage on susceptibility of gram-negative bacteria (GNB) to aminoglycosides is well documented (1, 5-7, 11, 13, 17, 19, 22-24, 28, 30). Those studies showed that frequent usage of amikacin usually results in no increase or only a slight increase in resistance to amikacin and a decrease in resistance to other aminoglycosides. However, in none of those studies were communityand hospital-acquired infections analyzed separately. Also, GNB isolated from all sites were included, and except in one study (6), invasive disease was not separated from colonization without invasion. Because all infections were combined, increases in amikacin resistance of nosocomial infections may have been "diluted" by the inclusion of large numbers of community-acquired isolates. Similarly, combining isolates from all sections of a hospital may mask significant changes in a specific area.Further motivation for this study was the lack of information on antimicrobial resistance levels in relation to aminoglycoside usage in developing countries, where overcrowded hospitals with very high rates of patient turnover are common.Because of increasing resistance of GNB to gentamicin, both the neonatal and general pediatric wards of our hospital changed to amikacin as the sole aminoglycoside for suspected GNB infections.The purpose of this study was to record prospectively the effect of intensive amikacin usage on the aminoglycoside resistance patterns of invasive hospital-acquired GNB in a busy pediatric department. MATERIALS AND METHODSPatient population. Baragwanath is the major hospital serving Soweto, South Africa (population of 1 to 2 million).

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Section: Discussionmentioning

confidence: 99%

“…One reported outbreak was caused by netilmicin-resistant S. marcescens shortly after netilmicin had been introduced as the primary aminoglycoside (16). Outbreaks of amikacinresistant but tobramycin-susceptible Acinetobacter spp.…”

Section: Discussionmentioning

confidence: 99%

Increased resistance to amikacin in a neonatal unit following intensive amikacin usage

Friedland

Funk

Khoosal

et al. 1992

Antimicrob Agents Chemother

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“…Outbreaks have been noted in neonatal and pediatric ICUs (4, 14, 18, 21, 28, 41, 60, 63, 74, 76, 88, 94, 95, 116, 133, 137, 150 , 198, 204, 215, 228, 239, 249, 250, 269, 270, 275, 309, 313, 338, 366, 393, 396, 400, 423), neonatal nurseries/units and special care baby units (7,100,156,190,238,275,310,359,362,387,423), pediatric oncology units (258), and maternity wards/hospitals (35,48).…”

Section: S Marcescensmentioning

confidence: 99%

“…From these pediatric nosocomial infection studies, many environmental sources or point sources have been found as reservoirs for S. marcescens, including hands of health care workers and exposure to health care workers (14,156,198,249,267,362,393,396,423), contaminated breast milk, formula, and breast pumps (133,156,204,274,393), contaminated parenteral nutrition (18), an infected neonate as the index patient or colonization of hospitalized infants (28,63,100,148,238,269,270,275,338,362,400), equipment such as incubators (28,198), laryngoscopes (95,204), suction tubes, soap dispensers (52), and waste jars (393), air conditioning ducts (387), contaminated hand brushes (7), contaminated disinfectants and soap (14,52,76,258,313,396), cotton wool pads (137), multidose nebulizer dropper bottles (215), and multidose medications (133).…”

Section: S Marcescensmentioning

confidence: 99%

Serratia Infections: from Military Experiments to Current Practice

2011

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SUMMARY Serratia species, in particular Serratia marcescens , are significant human pathogens. S. marcescens has a long and interesting taxonomic, medical experimentation, military experimentation, and human clinical infection history. The organisms in this genus, particularly S. marcescens , were long thought to be nonpathogenic. Because S. marcescens was thought to be a nonpathogen and is usually red pigmented, the U.S. military conducted experiments that attempted to ascertain the spread of this organism released over large areas. In the process, members of both the public and the military were exposed to S. marcescens , and this was uncovered by the press in the 1970s, leading to U.S. congressional hearings. S. marcescens was found to be a certain human pathogen by the mid-1960s. S. marcescens and S. liquefaciens have been isolated as causative agents of numerous outbreaks and opportunistic infections, and the association of these organisms with point sources such as medical devices and various solutions given to hospitalized patients is striking. Serratia species appear to be common environmental organisms, and this helps to explain the large number of nosocomial infections due to these bacteria. Since many nosocomial infections are caused by multiply antibiotic-resistant strains of S. marcescens , this increases the danger to hospitalized patients, and hospital personnel should be vigilant in preventing nosocomial outbreaks due to this organism. S. marcescens , and probably other species in the genus, carries several antibiotic resistance determinants and is also capable of acquiring resistance genes. S. marcescens and S. liquefaciens are usually identified well in the clinical laboratory, but the other species are rare enough that laboratory technologists may not recognize them. 16S rRNA gene sequencing may enable better identification of some of the less common Serratia species.

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“…Our first experience with the use of colistin for this purpose started in 1982. At that time we used MA supplemented with 200 i.u./ml colistin; in that previous study we investigated the circulation of S. marcescens strains during an outbreak in a neonatal intensive care unit (Montanaro et al 1984). The choice of this antibiotic as a selective agent depended upon the fact that resistance to colistin is very frequent in the genus Serratia and almost constant in S. marcescens (Grimont & Grimont, 1984).…”

Section: Discussionmentioning

confidence: 99%

Use of colistin and sorbitol for better isolation ofSerratia marcescensin clinical samples

et al. 1988

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A comparison was made of different culture media and procedures for detection of Serratia marcescens from faecal, pharyngeal and ocular swabs collected from 213 neonates. MacConkey agar and MacConkey agar with sorbitol (1%) and/or colistin (200 i.u./ml) were used both for primary isolation and after enrichment using Mossel Enterobacteriaceae broth with colistin (200 i.u./ml). The use of MacConkey agar supplemented with colistin for primary isolation improved considerably the isolation rate of S. marcescens from faecal swabs but not from pharyngeal swabs; the number of ocular isolations were insufficient to demonstrate differences between procedures. Moreover the enrichment procedures consistently increased the number of S. marcescens isolates especially from pharyngeal and ocular swabs. Use of sorbitol made detection of S. marcescens from clinical specimens easier and time- and cost-efficient.

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Epidemiological and bacteriological investigation ofSerratia marcescensepidemic in a nursery and in a neonatal intensive care unit

Cited by 22 publications

References 28 publications

Increased resistance to amikacin in a neonatal unit following intensive amikacin usage

Increased resistance to amikacin in a neonatal unit following intensive amikacin usage

Serratia Infections: from Military Experiments to Current Practice

Use of colistin and sorbitol for better isolation ofSerratia marcescensin clinical samples

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