Molecular Epidemiology of an Outbreak ofSerratia marcescensin a Neonatal Intensive Care Unit

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Abstract
Objective:: To investigate and control a biphasic outbreak ofSerratia marcescensin a neonatal intensive care unit (NICU).Design:: Epidemiological and laboratory investigation of the outbreak.Setting:: The NICU of the 1,470-bed teaching hospital of the University “Federico II,” Naples, Italy.Patients:: The outbreak involved 56 cases of colonization by Smarcescensover a 15-month period, with two epidemic peaks of 6 and 3 months, respectively. Fourteen (25%) of the 56 colonized infants developed clinical infections, 50% of which were major (sepsis, meningitis, or pneumonia).Methods:: Epidemiological and microbiological investigations, analysis of macrorestriction pattern of genomic DNA through pulsed-field gel electrophoresis (PFGE) of clinical and environmental isolates, and institution of infection control measures.Results:: Analysis of macrorestriction patterns of genomic DNA by PFGE demonstrated that the vast majority of Smarcescensisolates, including three environmental strains isolated from two handwashing disinfectants and the hands of a nurse, were of the same clonal type. The successful control of the outbreak was achieved through cohorting of noncolonized infants, isolation of Smarcescens-infectedand -colonized infants, and an intense educational program that emphasized the need for adherence to glove use and handwashing policies. The NICU remained open to new admissions.Conclusions:: Outbreaks caused by Smarcescensare very difficult to eradicate. An infection control program that includes molecular typing of microorganisms and the proper dissemination among staff members of the typing results is likely to be very effective in reducing NICU-acquired infections and in controlling outbreaks caused by Smarcescens,as well as other multiresistant bacteria.