Investigaton of three nosocomial outbreaks of Serratia marcescens in an intensive care unit in Sfax-Tunisia

##plugins.themes.academic_pro.article.main##

Sania Ktari
Faouzia Mahjoubi
Basma Mnif
Hatem Kallel
Mounir Bouaziz
Adnane Hammami

Abstract

The aim of the study was to type Serratia marcescens responsible for nosocomial outbreaks in an intensive care unit in Sfax -Tunisia.
Methods: The relatedness between S. marcescens isolates was studied by Pulsed field gel electrophoresis (PFGE). We included 56 strains of Serratia marcescens isolated from patients hospitalized in the intensive care unit during 2003 and 2004. Seven epidemiological unrelated strains of Serratia marcescens were also tested. Samples from environment and hands of the nursing and medical staff were collected and cultured to identify the source of contamination.
Results: All strains showed a wild type of antimicrobial susceptibility. PFGE typing revealed that three different clones were present. None of the cultures taken from hands of unit staff and from environmental samples yielded positive results for S. marcescens.
Conclusion: We have confirmed the presence of three consecutive outbreaks caused by three genetically unrelated bacterial clones of Serratia marcescens in the intensive care unit ward. These outbreaks are closely related to the frequent use of colistin and the lack of measures of hygiene in this ward.

Keywords:

Serratia marcescens, outbreak, typing

##plugins.themes.academic_pro.article.details##

References

  1. Yu WL, Lin CW, Wang DY. Serratia marcescens bacteremia: clinical features and antimicrobial suscetibilities of the isolates. J Microbiol Immunol Infect 1998;31:171-179.
  2. Su LH, Ou JT, Leu HS, Chiang PC, Chiu YP, Chia JH, et al. Extended epidemic of nosocomial urinary tract infections caused by Serratia marcescens. J clin Microbiol 2003;41:4726-4732
  3. Al-Harthi AA, Dagriri KA, Asindi AA, Bell CS. Neonatal meningitis. Saudi Med J 2000;21:550-553.
  4. Zaidi M, Sifuentes J, Bobadilla M, Moncada D, Ponce de Leon S. Epidemic of Serratia marcescens bacteremia and meningitis in a neonatal unit in Mexico City. Infect Control Hosp Epidemiol 1989;10:14-20.
  5. Korner RJ, Nicol A, Reeves DS, MacGowan AP, Hows J. Ciprofloxacin resistant Serratia marcescens endocarditis as a complication of non-Hodgkin lymphoma. J Infect 1994; 29:73- 76.
  6. Choi SH, Kim YS, Chung JW, Kim TH, Choo EJ, Kim MN, et al. Serratia bacteremia in a large university hospital: trends in antibiotic resistance during 10 years and implications for antibiotic use. Infect Control Hosp Epidemiol 2002;23:740-747.
  7. Cohen AL, Ridpath A, Noble-Wang J, Jensen B, Peterson AM, Arduino M, et al. Outbreak of Serratia marcescens bloodstream and central nervous system infections after interventional pain management procedures. Clin J Pain 2008;24:381-383.
  8. Sunenshine RH, Tan ET, Terashita DM, Jensen BJ, Kacica MA, Sickbert-Bennett EE, et al. A multistate outbreak of Serratia marcescens bloodstream infection associated with contaminated intrvenous magnesium sulfate from a compounding pharmacy. Clin Infect Dis 2007;45: 527-533.
  9. Villari P, Crispino M, Salvadori A, Scarcella A. Molecular epidemiology of an outbreak of Serratia marcescens in a neonatal intensive care unit I. Infec Control Hosp Epidemiol 2001;22:630- 634
  10. Mayhall CG. The epidemiology burn wound infections: then and now. Clin Infect Dis 2003; 37:543-550.
  11. Adjidé CC, Li-Thiao-Te V, Biendo M, Weibel B, Laurans G, Krim G, et al. Case control study of extended-spectrum betalactamase producing Serratia marcescens outbreak in a paediatric intensive care unit. Pathol Biol 2004;52:423-428.
  12. Der Sar-van der Brugge S, Arend SM, Bernerds AT, Berbee GAM, Westendorp RGJ, Feuth JDM, et al. Risk factors for acquisition of Serratia marcescens in a surgical Intensive Care Unit. J Hosp Infect 1999;41:291-299.
  13. Alfizah H, Nordiah AJ, Rozaidi WS. Using Pulsed Field Gel Electrophoresis in the molecular investigation of an outbreak of Serratia marcescens infection in an intensive carte unit. Singapore Med J 2004;45:214-218.
  14. Van der Vorm ER, Woldring-Zwaan C. Source, carriers, and management of a Serratia marcescens outbreak on a pulmonary unit. J Hosp Infect 2002;52:263-267.
  15. Perotti G, Bernardo ME, Spalla M, Matti C, Stronati M, Pagani L. Rapid control of two outbreaks of Serratia marcescens in a Northern Italian neonatal intensive care unit. J Chemother 2007; 2:56-60.
  16. Sartor C, Jacomo V, Duvivier C, Tissot-Dupont H, Sambuc R, Drancourt M. Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nononmedical soap. Infect Control Hosp Epidemiol 2000;21:196-199
  17. Manning ML, Archibald LK, Bell LM, Banerjee SN, Jarvis WR. Serratia marcescens transmission in a pediatric intensive care unit: A multifactorial occurrence. Am J Infect Control 2001;29: 115-119.
  18. Henry B, Plante-Jenkins C, Ostrowska K. An outbreak of Serratia marcescens associated with the anesthetic agent propofol. Am J Infect Control 2001;29:312-315.
  19. Tanaka T, Takahashi H, Kobayashi JM, Ohyama T, Okabe N. A nosocomial outbreak of febrile bloodstream infection caused by heparinized-saline contaminated with Serratia marcescens, Tokyo, 2002. Jpn J Infect Dis 2004;57:189-192.
  20. Fleisch F, Zimmermann-Baer U, Zbinden R, Bischoff G, Arlettaz R, Waldvogel K et al. Three consecutive outbreaks of Serratia marcescens in a neonatal intensive care unit. Clin Infect Dis 2002;34:767-773
  21. Berthelot P, Grattard F, Amerger C, Frery MC, Lucht F, Pozzetto B et al. Investigation of nosocomial outbreak due to Serratia marcescens in a maternity hospital. Infect Control Hosp Epidemiol 1999; 20:233-236.
  22. Alfieri N, Ramotar K, Armstrong P, Spornitz ME, Ross G,Winnick J, et al. Two consecutive outbreaks of Stenotrophomonas maltophilia (Xanthomonas maltophilia) in an intensive care unit defined by restriction fragment length polymorphism typing. Infect Control Hosp Epidemiol1999;20:553-556.
  23. Moolenaar RL, Crutcher JM, San Joaquin VH, Sewell LV, Hutwagner LC, Carson LA, et al. A prolonged outbreak of Pseudomonas aeruginoisa in a neonatal intensive care unit: did staff fingernaill play a role in disease transmission. Infect Control Hosp Epidemiol 2000;21:80-85.
  24. Hejazi A. The use of RAPD-PCR as a typing method for Serratia marcescens. J Med Microbiol 1997;46:913-919.
  25. Hejazi A, Aucken HM, Falkiner FR. Epidemiology and susceptibility of Serratia marcescens in a large general hospital over an 8-year period. J Hosp Infect 2000;45:42-46.
  26. Jones BL, Gorman LJ, Simpson J, Curran ET, McNamee S, Lucas C, et al. An outbreak of Serratia marcescens in two neonatal intensive care units. J Hosp Infect 2000;46:314-319.
  27. Jang TN, Fung CP, Yang TL, Shen SH, Huang CS, Lee SH. Use of pulsed-field electrophoresis to investigate an outbreak of Serratia marcescens infection in a neonatal intensive care unit. J Hosp Infect 2001;48:13-19.
  28. Braver DJ, Hauser GJ, Berns L, Siegman-Igra Y, Muhlbauer B. Control of a Serratia marcescens outbreak in a maternity hospital. J Hosp Infect 1987;10:129-37.
  29. David MD, Weller TM, Lambert P, Fraise AP. An outbreak of Serratia marcescens on the neonatal unit: a tale of two clones. J Hosp Infect 2006;63: 27-33.
  30. Miranda G, Kelly C, Solorzano F, Leanos B, 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;34:3138-3141.
  31. Kallel H, Bahloul M, Hergafi L, Akrout M, Ketata W, Chelly H, et al. Colistin as a salvage therapy for nosocomial infections caused by multidrug-resistant bacteria in the ICU. Int J Antimicrob Agents 2006;28:366-369.
  32. Ktari S, Arlet G, Mnif B, Gautier V, Mahjoubi F, Ben Jmeaa M, et al. Emergence of multidrug-resistant Klebsiella pneumoniae carrying blaVIM-4, blaCTXM-15 and blaCMY-4 in a Tunisian university hospital. Antimicrob Agents Chemother 2006;50:4198-4201.