First Italian outbreak of VIM-producing Serratia marcescens in an adult polyvalent intensive care unit, August-October 2018: A case report and literature review

Table 4 Previous hospital outbreaks of Serratia marcescens in Italy

Year	City	Setting	Number of cases(Infection and/or colonization)	Comments
1984	Naples[22]	NICU and Nursery	88	Outbreak linked to contaminated mucus aspiration apparatus and other contaminated instruments. Case fatality rate: 19%
1988	Genoa[23]	Adult ICU and surgical ward	11	Ventilators for assisted breathing became contaminated from index patient
1994	Varese[24]	Adult ICU	43	Strains from the ICU outbreak were multidrug resistance. 23 isolates from 18 other patients from other wards showed wide range of antibiotic susceptibility
2001	Naples[25]	NICU	14	56 cases of colonization by S marcescens over a 15-month period. Fourteen of the 56 colonized infants developed clinical infections, 50% of which were major (sepsis, meningitis, or pneumonia)
2003	Naples[26]	Adult ICU	13	Strain was multidrug resistant, inducible AmpC betalactamase producing. There were three cases of sepsis, nine pneumonia and one surgical wound infection. Mortality was 84.6%
2005	Modena[27]	NICU	15	Simultaneous outbreak of Serratia marcescens and Klebsiella pneumonia (11 cases). One preterm baby died in which both organisms were involved
2007	Pavia[9]	NICU	21	Occurred in two separate outbreaks in 10 mo interval
2009	Verona[28]	NICU	16	6 patients developed clinical diseases which included bacteremia, UTI, conjunctivitis and umbilical wound infection
2011	Pescara[7]	NICU	6	5 cases were linked toan index case hospitalised for S. marcescens sepsis. Mortality was 40%
2013	Modena[6]	NICU	127	Reported two long term outbreaks occurred over a period of 10 years. 43 developed infection and 3 died
2015	Floerence[5]	NICU	14	In the surveillance post outbreak, 18 out of 65 patients tested positive for S. marcescens

ICU: Intensive care unit; NICU: Neonatal ICU.