Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital

A clinical, epidemiologic, and laboratory perspective

Hee Jung Yoon, JunYong Choi, Yoon Soo Park, Chang Oh Kim, June Myung Kim, DongEun Yong, Kyungwon Lee, Young Goo Song

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Serratia marcescens is an aerobic gram-negative bacillus belonging to the family Enterobacteriacea. Infections caused by S marcescens may be difficult to treat because of their resistance to a variety of antibiotics, including β-lactams and aminoglycosides. Methods: This study aimed to (1) identify the risk factors associated with the development of Serratia marcescens bacteriuria in neurosurgical intensive care units (NSICU); (2) genotype the pathogens to determine the source of infection; (3) compare these results with antibiograms; and (4) determine and implement appropriate control measures. A retrospective case-control study of the epidemiologic data, the surveillance of environmental cultures, and the genotyping of strains using arbitrarily primed polymerase chain reaction (AP-PCR) were performed at a 750-bed, tertiary care teaching hospital. Seventy-four bacteriuria patients were compared with 74 age/sex-matched control patients in the NSICU between March 2002 and March 2004. The factors assessed were patient demographics; duration of hospital stay; duration of indwelling catheter use before and during stay in the NSICU; chronic underlying illnesses (diabetes mellitus, cardiovascular disease, malignancy); other sites of infection; history of trauma; exposure to a nasogastric tube; mechanical ventilation; urinary catheterization; central venous catheterization; surgical drainage; tracheostomy; brain or spine surgery; and receipt of total parenteral nutrition (TPN), antimicrobials (β-lactams, aminoglycosides, quinolones, carbapenems, vancomycins), or steroids. Results: Patients with S marcescens bacteriuria were more likely to have a longer NSICU stay and other sites of infection. Environmental surveillance showed the handling of urine jugs to be the point source of contamination. Genotyping and antibiograms of 14 patients were the same except for those of 2 patients. Conclusion: The patient-related risk factors were identified, and a rapid identification of the organism was made. Heightened surveillance, infection control measures, and empiric therapy led to improved methods for handling urine jugs, which terminated the outbreak.

Original languageEnglish
Pages (from-to)595-601
Number of pages7
JournalAmerican Journal of Infection Control
Volume33
Issue number10
DOIs
Publication statusPublished - 2005 Dec 1

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Bacteriuria
Serratia marcescens
Tertiary Healthcare
Teaching Hospitals
Disease Outbreaks
Intensive Care Units
Lactams
Microbial Sensitivity Tests
Aminoglycosides
Infection
Epidemiological Monitoring
Urine
Central Venous Catheterization
Urinary Catheterization
Carbapenems
Indwelling Catheters
Total Parenteral Nutrition
Environmental Monitoring
Tracheostomy
Quinolones

All Science Journal Classification (ASJC) codes

  • Microbiology
  • Infectious Diseases

Cite this

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title = "Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: A clinical, epidemiologic, and laboratory perspective",
abstract = "Background: Serratia marcescens is an aerobic gram-negative bacillus belonging to the family Enterobacteriacea. Infections caused by S marcescens may be difficult to treat because of their resistance to a variety of antibiotics, including β-lactams and aminoglycosides. Methods: This study aimed to (1) identify the risk factors associated with the development of Serratia marcescens bacteriuria in neurosurgical intensive care units (NSICU); (2) genotype the pathogens to determine the source of infection; (3) compare these results with antibiograms; and (4) determine and implement appropriate control measures. A retrospective case-control study of the epidemiologic data, the surveillance of environmental cultures, and the genotyping of strains using arbitrarily primed polymerase chain reaction (AP-PCR) were performed at a 750-bed, tertiary care teaching hospital. Seventy-four bacteriuria patients were compared with 74 age/sex-matched control patients in the NSICU between March 2002 and March 2004. The factors assessed were patient demographics; duration of hospital stay; duration of indwelling catheter use before and during stay in the NSICU; chronic underlying illnesses (diabetes mellitus, cardiovascular disease, malignancy); other sites of infection; history of trauma; exposure to a nasogastric tube; mechanical ventilation; urinary catheterization; central venous catheterization; surgical drainage; tracheostomy; brain or spine surgery; and receipt of total parenteral nutrition (TPN), antimicrobials (β-lactams, aminoglycosides, quinolones, carbapenems, vancomycins), or steroids. Results: Patients with S marcescens bacteriuria were more likely to have a longer NSICU stay and other sites of infection. Environmental surveillance showed the handling of urine jugs to be the point source of contamination. Genotyping and antibiograms of 14 patients were the same except for those of 2 patients. Conclusion: The patient-related risk factors were identified, and a rapid identification of the organism was made. Heightened surveillance, infection control measures, and empiric therapy led to improved methods for handling urine jugs, which terminated the outbreak.",
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Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital : A clinical, epidemiologic, and laboratory perspective. / Yoon, Hee Jung; Choi, JunYong; Park, Yoon Soo; Kim, Chang Oh; Kim, June Myung; Yong, DongEun; Lee, Kyungwon; Song, Young Goo.

In: American Journal of Infection Control, Vol. 33, No. 10, 01.12.2005, p. 595-601.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital

T2 - A clinical, epidemiologic, and laboratory perspective

AU - Yoon, Hee Jung

AU - Choi, JunYong

AU - Park, Yoon Soo

AU - Kim, Chang Oh

AU - Kim, June Myung

AU - Yong, DongEun

AU - Lee, Kyungwon

AU - Song, Young Goo

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N2 - Background: Serratia marcescens is an aerobic gram-negative bacillus belonging to the family Enterobacteriacea. Infections caused by S marcescens may be difficult to treat because of their resistance to a variety of antibiotics, including β-lactams and aminoglycosides. Methods: This study aimed to (1) identify the risk factors associated with the development of Serratia marcescens bacteriuria in neurosurgical intensive care units (NSICU); (2) genotype the pathogens to determine the source of infection; (3) compare these results with antibiograms; and (4) determine and implement appropriate control measures. A retrospective case-control study of the epidemiologic data, the surveillance of environmental cultures, and the genotyping of strains using arbitrarily primed polymerase chain reaction (AP-PCR) were performed at a 750-bed, tertiary care teaching hospital. Seventy-four bacteriuria patients were compared with 74 age/sex-matched control patients in the NSICU between March 2002 and March 2004. The factors assessed were patient demographics; duration of hospital stay; duration of indwelling catheter use before and during stay in the NSICU; chronic underlying illnesses (diabetes mellitus, cardiovascular disease, malignancy); other sites of infection; history of trauma; exposure to a nasogastric tube; mechanical ventilation; urinary catheterization; central venous catheterization; surgical drainage; tracheostomy; brain or spine surgery; and receipt of total parenteral nutrition (TPN), antimicrobials (β-lactams, aminoglycosides, quinolones, carbapenems, vancomycins), or steroids. Results: Patients with S marcescens bacteriuria were more likely to have a longer NSICU stay and other sites of infection. Environmental surveillance showed the handling of urine jugs to be the point source of contamination. Genotyping and antibiograms of 14 patients were the same except for those of 2 patients. Conclusion: The patient-related risk factors were identified, and a rapid identification of the organism was made. Heightened surveillance, infection control measures, and empiric therapy led to improved methods for handling urine jugs, which terminated the outbreak.

AB - Background: Serratia marcescens is an aerobic gram-negative bacillus belonging to the family Enterobacteriacea. Infections caused by S marcescens may be difficult to treat because of their resistance to a variety of antibiotics, including β-lactams and aminoglycosides. Methods: This study aimed to (1) identify the risk factors associated with the development of Serratia marcescens bacteriuria in neurosurgical intensive care units (NSICU); (2) genotype the pathogens to determine the source of infection; (3) compare these results with antibiograms; and (4) determine and implement appropriate control measures. A retrospective case-control study of the epidemiologic data, the surveillance of environmental cultures, and the genotyping of strains using arbitrarily primed polymerase chain reaction (AP-PCR) were performed at a 750-bed, tertiary care teaching hospital. Seventy-four bacteriuria patients were compared with 74 age/sex-matched control patients in the NSICU between March 2002 and March 2004. The factors assessed were patient demographics; duration of hospital stay; duration of indwelling catheter use before and during stay in the NSICU; chronic underlying illnesses (diabetes mellitus, cardiovascular disease, malignancy); other sites of infection; history of trauma; exposure to a nasogastric tube; mechanical ventilation; urinary catheterization; central venous catheterization; surgical drainage; tracheostomy; brain or spine surgery; and receipt of total parenteral nutrition (TPN), antimicrobials (β-lactams, aminoglycosides, quinolones, carbapenems, vancomycins), or steroids. Results: Patients with S marcescens bacteriuria were more likely to have a longer NSICU stay and other sites of infection. Environmental surveillance showed the handling of urine jugs to be the point source of contamination. Genotyping and antibiograms of 14 patients were the same except for those of 2 patients. Conclusion: The patient-related risk factors were identified, and a rapid identification of the organism was made. Heightened surveillance, infection control measures, and empiric therapy led to improved methods for handling urine jugs, which terminated the outbreak.

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