Affiliations: Department of Medical Microbiology and Parasitology,
School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan,
Malaysia | Infection Control and Epidemiology Unit, Hospital
Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Note: [] Correspondence: Dr. Zaidah Abdul Rahman, Department of Medical
Microbiology and Parasitology, School of Medical Sciences, Universiti Sains
Malaysia, Kubang Kerian, Kelantan, Malaysia. Tel.: +609 7676249; Fax: 609
7653370; E-mail: drzaidah@kb.usm.my
Abstract: Serratia marcescens previously was thought to be a low pathogenic
bacterium but has recently being recognized as a nosocomial pathogen. In May
2007, patients with nosocomial septicemia caused by S. marcescens were
identified in a neonatal intensive care unit (NICU) at a tertiary-teaching
hospital. The objective of this report is to highlight the rare source of the
S. marcescens outbreak. Here, we describe the investigations and outcomes
of this outbreak. Case subject was defined as any neonate receiving medical
care at the NICU, from one week before the index patient became symptomatic and
onwards, with clinical signs and symptoms of sepsis, with or without a positive
blood culture, which yielded S. marcescens. Chart reviews were conducted
for case subjects. Various samples from the NICU were sent for sterility
testing including medications, solutions, used and freshly prepared total
parenteral nutrition (TPN) from the NICU and the pharmacy unit. The specimens
were processed and positive isolates were identified as S. marcescens
using standard microbiological methods. it S. marcescens isolates were
subjected to pulsed field gel electrophoresis for molecular typing and source
identification. S. marcescens were isolated from five neonates, used TPN
and freshly prepared TPN of different batches in pharmacy. None of the
environmental samples and medications grew S. marcescens. Analysis of
macrorestriction patterns of genomic DNA by pulsed field gel electrophoresis
demonstrated indistinguishable patterns. This outbreak was related to bacterial
contamination of TPN. This report points at a rare source of S.
marcescens outbreak. However, targeted investigations and immediate active
interventions enabled the managing team to control the outbreak in the
NICU.
Keywords: S. marcescens, outbreak, septicemia, total parenteral nutrition, neonatal intensive care unit
