Management of multidrug-resistant Serratia marcescens outbreak in a tertiary cardiac care center’s pediatric ward: a comprehensive analysis
DOI:
https://doi.org/10.61529/idjp.v34i2.299Abstract
Background: S. marcescens is the one most commonly associated with human infections, known for causing serious hospital acquired infections, particularly in those who are immunocompromised, critically ill patients, mainly in settings such as intensive care units (ICUs), especially neonatal units (NICUs). Outbreaks of Serratia marcescens are often linked to poor environmental disinfection. The primary objective of this study was the identification of the source of infection and management of this outbreak.
Material and Methods: A prospective cross-sectional study was carried out from September to November 2022 to investigate the increase in Carbapenem-resistant Serratia marcescens bloodstream infections. (BSIs)
Results: A total of 21 patients meeting the case definition of Carbapenem-resistant Serratia marcescens bloodstream infections were identified during the outbreak period. Three main groups of observations were identified through detailed rounds and audits that could have contributed to this outbreak: overcrowding, antibiotic use and limitations in implementation of satisfactory infection prevention and control practices especially poor hand hygiene. Environmental Cultures findings showed isolation of Pseudomonas species, MRSA and Burkholderia cepacia however Serratia marcescens was not detected.
Conclusion: A concerted effort involving healthcare facilities, healthcare workers, patients, and public health agencies is essential for the effective prevention of Serratia outbreaks, requiring continuous vigilance, education, and adherence to infection control measures.
Keywords: Intensive care units, Neonatal intensive care units, Bloodstream infections, Multidrug resistant
References
Yeo KT, Octavia S, Lim K, Lin C, Lin R, Thoon KC, et al. Serratia marcescens in the neonatal intensive care unit: A cluster investigation using molecular methods. J Infect Public Health. 2020; 13(7): 1006-11. DOI: https://doi.org/10.1016/j.jiph.2019.12.003
Cristina ML, Sartini M, Spagnolo AM. Serratia marcescens infections in neonatal intensive care units (NICUs). Int J Environ Res Public Health. 2019; 16(4): 610. DOI: https://doi.org/10.3390/ijerph16040610
Guel-Gomez M, Angulo-Zamudio UA, Leon-Sicairos N, Flores-Villaseñor H, Mendívil-Zavala E, Plata-Guzmán A, et al. Outbreak of Serratia marcescens in the neonatal intensive care unit of a Tertiary Care Hospital in Mexico. Adv Med. 2023; 2023: 3281910. DOI: https://doi.org/10.1155/2023/3281910
Muyldermans A, Crombé F, Bosmans P, Cools F, Piérard D, Wybo I. Serratia marcescens outbreak in a neonatal intensive care unit and the potential of whole-genome sequencing. J Hosp Infect. 2021; 111: 148-54. DOI: https://doi.org/10.1016/j.jhin.2021.02.006
Cristina ML, Sartini M, Spagnolo AM. Serratia marcescens infections in neonatal intensive care units (NICUs). Int J Environ Res Public Health. 2019; 16(4): 610. DOI: https://doi.org/10.3390/ijerph16040610
Montagnani C, Cocchi P, Lega L, Campana S, Biermann KP, Braggion C, et al. Serratia marcescens outbreak in a neonatal intensive care unit: crucial role of implementing hand hygiene among external consultants. BMC Infect Dis. 2015; 15(1): 1-5. DOI: https://doi.org/10.1186/s12879-014-0734-6
Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-Central Line Associated Bloodstream Infection) CDC Jan; 2024. Available from: https://www.cdc.gov/nhsn/pdfs/validation/2024/pcsmanual_2024.pdf
Flannery DD, Chiotos K, Gerber JS, Puopolo KM. Neonatal multidrug-resistant gram-negative infection: Epidemiology, mechanisms of resistance, and management. Pediatr Res. 2022; 91(2): 380-91. DOI: https://doi.org/10.1038/s41390-021-01745-7
Mills JP, Marchaim D. Multidrug-resistant gram-negative bacteria: Infection prevention and control update. Infect Dis Clin. 2021; 35(4): 969-94. DOI: https://doi.org/10.1016/j.idc.2021.08.001
Millán-Lou MI, López C, Bueno J, Pérez-Laguna V, Lapresta C, Fuertes ME, et al. Successful control of Serratia marcescens outbreak in a neonatal unit of a tertiary-care hospital in Spain. Enferm Infecc Microbiol Clin (Engl Ed). 2021: S0213-005X(21)00186-5. DOI: https://doi.org/10.1016/j.eimc.2021.05.003
Gupta V, Sharma S, Pal K, Goyal P, Agarwal D, Chander J. Serratia, no longer an uncommon opportunistic pathogen–Case series & review of literature. Infect Disord Drug Targets. 2021; 21(7): e300821191666. DOI: https://doi.org/10.2174/1871526521666210222125215
Tavares-Carreon F, De Anda-Mora K, Rojas-Barrera IC, Andrade A. Serratia marcescens antibiotic resistance mechanisms of an opportunistic pathogen: A literature review. PeerJ. 2023; 11: e14399. DOI: https://doi.org/10.7717/peerj.14399
Mahlen SD. Serratia infections: From military experiments to current practice. Clin Microbiol Rev. 2011; 24(4): 755-91. DOI: https://doi.org/10.1128/cmr.00017-11
Loo LH, Ong CC, Farhanah S, Linn KZ, Huan X, Marimuthu K. SG-APSIC1099: Scoping review of cleaning of high-touch surfaces (HTSs) in inpatient wards. Antimicrob Steward Healthc Epidemiol. 2023; 3(S1): s12. DOI: https://doi.org/10.1017/ash.2023.37
Roy MC, Stevens M, Fidsa FS. Guide to infection control in clinical settings. Center for Health Protection. Available from: https://www.chp.gov.hk/files/pdf/guide to_infe ction_control_in_clinic_setting.pdf
Browne K, White N, Tehan P, Russo PL, Amin M, Stewardson AJ, et al. A randomised controlled trial investigating the effect of improving the cleaning and disinfection of shared medical equipment on healthcare-associated infections: the CLEaning and Enhanced disiNfection (CLEEN) study. Trials. 2023; 24(1): 133. DOI: https://doi.org/10.1186/s13063-023-07144-z
Ng WH, Yong J, Chew KL, Li J, Pharm M. 244. Impact of antibiotic susceptibility reporting on broad-spectrum antibiotic use in serratia and morganella bacteremia. Open Forum Infect Dis. 2018; 5 (Suppl 1): S104. DOI: https://doi.org/10.1093/ofid/ofy210.255
de Jesus Marçal H, Madalosso G, Assis D, Padoveze MC. Outbreaks of healthcare-associated infections in Sao Paulo State, Brazil: Results from a statewide monitoring system. Infect Control Hosp Epidemiol. 2020; 41(S1): s338-.
De Rooij D, Belfroid E, Eilers R, Roßkamp D, Swaan C, Timen A. Qualitative research: institutional preparedness during threats of infectious disease outbreaks. BioMed Res Int. 2020; 41 (S1); s338. DOI: https://doi.org/10.1017/ice.2020.947
Staats GJ, Mc Carlie SJ, Boucher-van Jaarsveld CE, Bragg RR. Susceptibility tests and predictions of transporter profile in Serratia species. Microorganisms. 2022; 10(11): 2257. DOI: https://doi.org/10.3390/microorganisms10112257
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Faiza Rezwan

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.