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462 Outbreak of Serratia marcescens Colonization and Bacteremia in a Neonatal Intensive Care Unit

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Ju-Ae Lee, RN , Konkuk Univ. Hospital, Seoul, South Korea
Ji-Hye Moon, RN , Inha University Hospital, Seoul, South Korea
Sohn-Yoon Baik, RN , Bundang Cha Hospital, Seoul, South Korea
Joung-A Seo, RN , Ewha University Mokdong Hospital, Seoul, South Korea
Hee-Jung Son, RN , Ewha University Mokdong Hospital, Seoul, South Korea
Soon-Seon Oh, RN , Eulji Hospital, Seoul, South Korea
Sun-Ju Jung, RN , Hanyang University Hospital, Seoul, South Korea
Hye-Ran Jung, RN , Wonju Christian Hospital, Seoul, South Korea
Mi-Kyoung Pyon, RN , Asan Medical Center, Seoul, South Korea
Jae Sim Jeong, RN, MPH, PhD, KCIC , University of Ulsan, Seoul, South Korea
Background: Six S. marcescens colonizations have been notified in August 2008 and followed by two colonizations and one bacteremia among neonates in a Neonatal Intensive Care Unit (NICU) at 640-beds university-affiliated hospital in Seoul from August to September, 2008. The antibiograms of isolated S. marcescens were similar and most cases were developed among prematurities.  

Objective: Outbreak investigation initiated to identify risk factors and prevent further transmission or infection of S. marcescens.

Methods: Retrospective case-control study, surveillance cultures for environment, and infection control practice observations were performed. Nine cases which developed colonizations or infections were compared with 18 neonates who were negative in clinical or surveillance cultures at the same time during outbreak. Breast milk, antiseptics and disinfectant, and any other humid environment in NICU were cultured to rule out the possibility of environmental sources. Hand hygiene, contact precautions, and environmental disinfection were reinforced.

Results: In univariate comparison of risk factors, admission form outside (p=.013), prematurity (p=.003), intrauterine growth retardation (p=,029), and use of total parenteral nutrition (TPN) (p=.001), umbilical artery (p=.008) and venous catheters (p=.026), peripherally inserted central venous catheters (p=.026), intubation (p=.026), ventilator (p=.006), oral suction (p=.004), and peripheral IV catheters (p=.026] showed higher frequency in cases. In multivariate logistic analysis, outside admissions (OR=13.84, 95% CI=1.05-182.84, p=.046) and TPN (OR=18.26, 95% CI=1.43-232.68 , p=.025) were independently associated with S. marcescens isolation. Among 45 samples of environmental cultures, one in 3 suction catheters and 5 in 7 seven incubator humidifiers were positive in S. marcescens and gram negative bacilli, retrospectively. And other devices, disinfectants, and environments in NICU were all negative.

Conclusions: After the investigation and the application of reinforced infection control practices, there were no more S. marcescens colonizations or infections. It was assumed that TPN related factors and unknown outside sources were probably related to this outbreak.