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Tirani MM, Pourajam S, Nikbin VS, Shirzadi M, Solgi H. Investigation and control of two consecutive Serratia marcescens outbreaks linked to reusable LigaSure devices in an operating room. Antimicrob Resist Infect Control 2025; 14:54. [PMID: 40390129 PMCID: PMC12090382 DOI: 10.1186/s13756-025-01570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Accepted: 05/07/2025] [Indexed: 05/21/2025] Open
Abstract
BACKGROUND Serratia marcescens is an opportunistic gram-negative bacterium that is commonly associated with sudden outbreaks of various healthcare-associated infections in healthcare settings. This study describes two consecutive mini-outbreaks of S. marcescens in an operating room following laparoscopic sleeve gastrectomy procedures. METHODS Between December 16 and 26, 2020, five patients who underwent sleeve gastrectomy at a university hospital were re-admitted with clinical symptoms. An investigation by the infection control team was conducted to identify the source. Environmental and instrument samples were collected, and antimicrobial susceptibility testing was performed. Molecular typing using pulsed-field gel electrophoresis (PFGE) was conducted to assess the genetic relatedness of the isolates. Infection control interventions were implemented during the outbreak. FINDINGS During this period, four of the five patients tested positive for S. marcescens. A total of 31 surveillance samples were collected, isolates from the handle of one LigaSure and the grasper of another were also positive for S. marcescens. PFGE revealed two distinct clones, indicating two separate outbreaks. Four of the six isolates from samples of patients and environment were the same, while two isolates belonging to another clone were collected from the blood samples of patients. After discontinuation of the reused LigaSure devices and implementation of strict infection control measures, no new cases were reported. CONCLUSION The two consecutive S. marcescens outbreaks were linked to the reuse of inadequately sterilized LigaSure devices. The implementation of targeted infection control measures successfully halted further transmission.
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Affiliation(s)
| | - Samaneh Pourajam
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mohammad Shirzadi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Solgi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Amin Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
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Shaik Ismail B, Toh HX, Seah JH, Tan KY, Lee LC, Tay YY, Khong KC, Seet AWM, Tesalona KC, Ngeow AJH, Ho SKY, Poon WB, Lai DCM, Ko KKK, Ling ML. Serratia marcescens outbreak at a neonatal intensive care unit in an acute care tertiary hospital in Singapore. J Hosp Infect 2025; 156:21-25. [PMID: 39447651 DOI: 10.1016/j.jhin.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 09/21/2024] [Accepted: 10/05/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND Serratia marcescens is an aerobic Gram-negative Enterobacterales bacillus that has emerged as a cause of hospital-associated infections. AIM To report the epidemiological, diagnostic, and genetic investigation of an outbreak involving five neonatal patients infected or colonized with S. marcescens including the infection control interventions. METHODS The outbreak occurred in a 28-bedded neonatal unit in an acute care tertiary hospital in Singapore divided into three areas: two negative-pressure airborne infection isolation rooms with a shared anteroom, 10 neonatal intensive care unit (NICU) beds, and 16 high-dependency beds. In-flight patients and their immediate environment were screened for S. marcescens to determine probable environmental sources. Whole-genome sequencing (WGS) analysis of resulting isolates was performed to determine clone relatedness and possible transmission patterns. Implementation of infection control interventions included prompt isolation of cases, enhanced equipment and environmental disinfection, use of alcohol-based hand rub as the preferred hand hygiene mode, enhanced infection prevention orientation for parents, review of practices, audits, and immediate feedback on non-compliance. FINDINGS Five neonates infected or colonized with S. marcescens were involved in this outbreak. Four were infection cases and one was identified through contact tracing. Three NICU sinks and the milk preparation room sink were tested positive for S. marcescens. WGS confirmed clonality of strains from two NICU sinks, and milk preparation room sink with that of the five neonates. CONCLUSION A multi-prong strategy was required to contain this outbreak. WGS analysis showed association of biofilms in sinks with the outbreak.
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Affiliation(s)
- B Shaik Ismail
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore.
| | - H X Toh
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - J H Seah
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - K Y Tan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - L C Lee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Y Y Tay
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - K C Khong
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - A W M Seet
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - K C Tesalona
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - A J H Ngeow
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - S K Y Ho
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - W B Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - D C M Lai
- Department of Molecular Pathology, Singapore General Hospital, Singapore
| | - K K K Ko
- Department of Microbiology, Singapore General Hospital, Singapore
| | - M L Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
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3
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Arora S, Myat Oo A, Shaik Ismail B, Poon WB, Lai D, Ko KKK, Wong HM, Tan KY, Aung MK, Conceicao E, Yang Y, Chan DYW, Sim JXY, Venkatachalam I, Lee LC, Ling ML. Rapid management of Serratia marcescens outbreak in neonatology unit in Singapore: Risk factors and infection control measures. Am J Infect Control 2024; 52:1084-1090. [PMID: 38761850 DOI: 10.1016/j.ajic.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND We describe the investigations for control of two consecutive Serratia marcescens outbreaks in neonatology unit of Singapore General Hospital. METHODS Epidemiological investigations, environmental sampling and risk-factors analysis were performed to guide infection control measures. Active surveillance sampling of nasopharyngeal aspirate and/or stool from neonates was conducted during both outbreaks. Whole-genome-sequencing was done to determine clonal links. Retrospective case-control study was conducted for second outbreak to identify risk factors for S marcescens acquisition. RESULTS In 2022, two genetically unrelated S marcescens outbreaks were managed involving five neonates in March 2022 (outbreak 1) and eight neonates in November 2022 (outbreak 2). A link to positive isolates from sinks in intensive care units and milk preparation room was identified during outbreak 1. Neonatal jaundice (aOR, 16.46; p-value= 0.023) and non-formula milk feeding (aOR, 13.88; p-value= 0.02) were identified as risk factors during second outbreak. Multiple interventions adopted were cohorting of positive cases, carriage-screening, enhanced environmental cleaning, and emphasis on alcohol-based handrubs for hand-hygiene. CONCLUSION The two outbreaks were likely due to infection prevention practices lapses and favourable environmental conditions. Nosocomial S marcescens outbreaks in neonatology units are difficult to control and require multidisciplinary approach with strict infection prevention measures to mitigate risk factors.
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Affiliation(s)
- Shalvi Arora
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore.
| | - Aung Myat Oo
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Bushra Shaik Ismail
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Woei Bing Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore, Singapore
| | - Deborah Lai
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore; Department of Molecular Pathology, Singapore General Hospital, Singapore, Singapore
| | - Karrie Kwan Ki Ko
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Hei Man Wong
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Kwee Yuen Tan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Edwin Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Yong Yang
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Darius Yak Weng Chan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Jean Xiang Ying Sim
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Indumathi Venkatachalam
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Lai Chee Lee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore, Singapore
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Hopkins HA, Lopezguerra C, Lau MJ, Raymann K. Making a Pathogen? Evaluating the Impact of Protist Predation on the Evolution of Virulence in Serratia marcescens. Genome Biol Evol 2024; 16:evae149. [PMID: 38961701 PMCID: PMC11332436 DOI: 10.1093/gbe/evae149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/25/2024] [Accepted: 06/30/2024] [Indexed: 07/05/2024] Open
Abstract
Opportunistic pathogens are environmental microbes that are generally harmless and only occasionally cause disease. Unlike obligate pathogens, the growth and survival of opportunistic pathogens do not rely on host infection or transmission. Their versatile lifestyles make it challenging to decipher how and why virulence has evolved in opportunistic pathogens. The coincidental evolution hypothesis postulates that virulence results from exaptation or pleiotropy, i.e. traits evolved for adaptation to living in one environment that have a different function in another. In particular, adaptation to avoid or survive protist predation has been suggested to contribute to the evolution of bacterial virulence (the training ground hypothesis). Here, we used experimental evolution to determine how the selective pressure imposed by a protist predator impacts the virulence and fitness of a ubiquitous environmental opportunistic bacterial pathogen that has acquired multidrug resistance: Serratia marcescens. To this aim, we evolved S. marcescens in the presence or absence of generalist protist predator, Tetrahymena thermophila. After 60 d of evolution, we evaluated genotypic and phenotypic changes by comparing evolved S. marcescens with the ancestral strain. Whole-genome shotgun sequencing of the entire evolved populations and individual isolates revealed numerous cases of parallel evolution, many more than statistically expected by chance, in genes associated with virulence. Our phenotypic assays suggested that evolution in the presence of a predator maintained virulence, whereas evolution in the absence of a predator resulted in attenuated virulence. We also found a significant correlation between virulence, biofilm formation, growth, and grazing resistance. Overall, our results provide evidence that bacterial virulence and virulence-related traits are maintained by selective pressures imposed by protist predation.
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Affiliation(s)
- Heather A Hopkins
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC, USA
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Christian Lopezguerra
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC, USA
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Meng-Jia Lau
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC, USA
| | - Kasie Raymann
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC, USA
- Department of Biology, University of North Carolina Greensboro, Greensboro, NC, USA
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5
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Calbo E, Gisbert L, López-Sánchez M. Investigating outbreaks in neonatal intensive care units: A crucial battle in the cradle of care. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:283-285. [PMID: 38839161 DOI: 10.1016/j.eimce.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Esther Calbo
- Servicio de Enfermedades Infecciosas Hospital Universitario Mútua de Terrassa, Spain; Equipo Control de Infección, Spain; Universitat Internacional de Catalunya, Spain.
| | - Laura Gisbert
- Servicio de Enfermedades Infecciosas Hospital Universitario Mútua de Terrassa, Spain
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Liébana-Rodríguez M, Portillo-Calderón I, Fernández-Sierra MA, Delgado-Valverde M, Martín-Hita L, Gutiérrez-Fernández J. Nosocomial outbreak caused by Serratia marcescens in a neonatology intensive care unit in a regional hospital. Analysis and improvement proposals. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:286-293. [PMID: 37331927 DOI: 10.1016/j.eimce.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/04/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES Serratia marcescens (SM) may cause nosocomial outbreaks in Neonatal Intensive Care Units (NICU). We describe an outbreak of SM in a NICU and propose additional prevention and control recommendations. METHODS Between March 2019 and January 2020, samples were taken from patients in the NICU (rectal, pharyngeal, axillary and other locations) and from 15 taps and their sinks. Control measures were implemented including thorough cleaning of incubators, health education to staff and neonates'relatives, and use of single-dose containers. PFGE was performed in 19 isolates from patients and in 5 environmental samples. RESULTS From the first case in March 2019 to the detection of the outbreak, a month elapsed. Finally, 20 patients were infected and 5 colonized. 80% of infected neonates had conjunctivitis, 25% bacteremia, 15% pneumonia, 5% wound infection, and 5% urinary tract infection. Six neonates had two foci of infection. Among the 19 isolates studied, 18 presented the same pulsotype and only one of the isolates from the sinkhole showed a clonal relationship with those of the outbreak. Initial measures established were ineffective to control de outbreak and were implemented with exhaustive cleaning, use of individual eye drops, environmental sampling and changing sinks. CONCLUSION This outbreak presented a high number of neonates affected due to its late detection and torpid evolution. The microorganisms isolated from the neonates were related to an environmental isolate. Additional prevention and control measures are proposed, including routine weekly microbiological sampling.
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Affiliation(s)
- María Liébana-Rodríguez
- Departamento de Medicina Preventiva y Salud Pública, Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain
| | - Inés Portillo-Calderón
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBiS). Sevilla, Spain
| | - María Amelia Fernández-Sierra
- Departamento de Medicina Preventiva y Salud Pública, Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain
| | - Mercedes Delgado-Valverde
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBiS). Sevilla, Spain
| | - Lina Martín-Hita
- Departamento de Microbiología, Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada (Ibs-Granada), Granada, Spain
| | - José Gutiérrez-Fernández
- Departamento de Microbiología, Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada (Ibs-Granada), Granada, Spain; Departamento de Microbiología, Universidad de Granada-Instituto de Investigación Biosanitaria de Granada (Ibs-Granada), Granada, Spain.
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7
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Liébana-Rodríguez M, Recacha-Villamor E, Díaz-Molina C, Pérez-Palacios P, Martín-Hita L, Enríquez-Maroto F, Gutiérrez-Fernández J. Outbreaks by Klebsiella oxytoca in neonatal intensive care units: Analysis of an outbreak in a tertiary hospital and systematic review. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:294-301. [PMID: 37328344 DOI: 10.1016/j.eimce.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/10/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Klebsiella oxytoca can cause nosocomial infections, affecting vulnerable newborns. There are few studies describing nosocomial outbreaks in the neonatal intensive care units (NICU). In this study, a systematic review of the literature was carried out to know the main characteristics of these outbreaks and the evolution of one is described. METHODS We conducted a systematic review in the Medline database up to July 2022, and present a descriptive study of an outbreak with 21 episodes in the NICU of a tertiary hospital, between September 2021 and January 2022. RESULTS 9 articles met the inclusion criteria. The duration of outbreaks was found to be variable, of which 4 (44.4%) lasted for a year or more. Colonization (69%) was more frequent than infections (31%) and the mortality rate was 22.4%. In studies describing sources, the most frequent was the environmental origin (57.1%). In our outbreak there were 15 colonizations and 6 infections. The infections were mild conjunctivitis without sequelae. Molecular typing analysis made it possible to detect 4 different clusters. CONCLUSIONS There is an important variability in the evolution and results of the published outbreaks, highlighting a greater number of colonized, use of PFGE (pulsed-field gel electrophoresis) techniques for molecular typing and implementation of control measures. Finally, we describe an outbreak in which 21 neonates were affected with mild infections, resolved without sequelae and whose control measures were effective.
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Affiliation(s)
- María Liébana-Rodríguez
- Departamento de Medicina Preventiva y Salud Pública, Hospital Virgen de las Nieves. Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain
| | - Esther Recacha-Villamor
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Carmen Díaz-Molina
- Departamento de Medicina Preventiva y Salud Pública, Hospital Virgen de las Nieves. Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain
| | - Patricia Pérez-Palacios
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Lina Martín-Hita
- Departamento de Microbiología. Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain
| | - Francisca Enríquez-Maroto
- Departamento de Medicina Preventiva y Salud Pública, Hospital Virgen de las Nieves. Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain
| | - José Gutiérrez-Fernández
- Departamento de Microbiología. Hospital Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain; Departamento de Microbiología, Universidad de Granada-Instituto de Investigación Biosanitaria de Granada, Ibs-Granada, Granada, Spain.
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8
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Merla C, Ramus M, Kuka A, Mileto I, Gaiarsa S, Di Comite A, Corbella M, Piralla A, Lanave ML, Muzzi A, Ghirardello S, Baldanti F, Cambieri P. Impact of Whole Genome Sequencing to investigate transmission of Serratia marcescens in Neonatal Intensive Care Unit. J Infect Public Health 2024; 17:918-921. [PMID: 38574416 DOI: 10.1016/j.jiph.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024] Open
Abstract
Newborns admitted to neonatal intensive care units (NICU) are at increased risk of health care-associated infections. Serratia marcescens represent the third most common pathogen in NICU outbreaks. Here we present an outbreak investigation performed using Whole Genome Sequencing (WGS) analyses and the control measures implemented to limit the spread of S. marcescens in the NICU of an Italian hospital. In February 2023 S. marcescens was isolated from six newborns, when in 2022 this pathogen was isolated only from two samples in the same ward. Measures for infection prevention were adopted. Routinary surveillance screening, performed with rectal swabs collected at admission and weekly thereafter, was implemented to search for S. marcescens presence. Environmental samples were collected. All the isolates, obtained from the conjunctival swab of six newborns, from rectal swab of two newborns who did not develop infections, as well as from the aerators of two faucets, were sequenced. WGS analyses showed no correlation between the isolates from newborns and environmental isolates. The implementation of the measures for infection prevention and control had enabled us to successfully control the outbreak within a short period. WGS analyses proved to be crucial in outbreak investigation to limit the spreading of the pathogens.
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Affiliation(s)
- Cristina Merla
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
| | - Marina Ramus
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy; Specialization School of Microbiology and Virology, University of Pavia, Italy
| | - Angela Kuka
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy; Specialization School of Microbiology and Virology, University of Pavia, Italy
| | - Irene Mileto
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy; Specialization School of Microbiology and Virology, University of Pavia, Italy
| | - Stefano Gaiarsa
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Amelia Di Comite
- Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Marta Corbella
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Antonio Piralla
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Alba Muzzi
- Medical Direction, Foundation IRCCS San Matteo Hospital, Pavia, Italy
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Fausto Baldanti
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia. Pavia, Italy
| | - Patrizia Cambieri
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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9
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Sterzi L, Nodari R, Di Marco F, Ferrando ML, Saluzzo F, Spitaleri A, Allahverdi H, Papaleo S, Panelli S, Rimoldi SG, Batisti Biffignandi G, Corbella M, Cavallero A, Prati P, Farina C, Cirillo DM, Zuccotti G, Bandi C, Comandatore F. Genetic barriers more than environmental associations explain Serratia marcescens population structure. Commun Biol 2024; 7:468. [PMID: 38632370 PMCID: PMC11023947 DOI: 10.1038/s42003-024-06069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Bacterial species often comprise well-separated lineages, likely emerged and maintained by genetic isolation and/or ecological divergence. How these two evolutionary actors interact in the shaping of bacterial population structure is currently not fully understood. In this study, we investigate the genetic and ecological drivers underlying the evolution of Serratia marcescens, an opportunistic pathogen with high genomic flexibility and able to colonise diverse environments. Comparative genomic analyses reveal a population structure composed of five deeply-demarcated genetic clusters with open pan-genome but limited inter-cluster gene flow, partially explained by Restriction-Modification (R-M) systems incompatibility. Furthermore, a large-scale research on hundred-thousands metagenomic datasets reveals only a partial habitat separation of the clusters. Globally, two clusters only show a separate gene composition coherent with ecological adaptations. These results suggest that genetic isolation has preceded ecological adaptations in the shaping of the species diversity, an evolutionary scenario coherent with the Evolutionary Extended Synthesis.
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Affiliation(s)
- Lodovico Sterzi
- Department of Biomedical and Clinical Sciences, Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", Università Di Milano, 20157, Milan, Italy
| | - Riccardo Nodari
- Department of Biomedical and Clinical Sciences, Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", Università Di Milano, 20157, Milan, Italy
| | - Federico Di Marco
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Laura Ferrando
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Saluzzo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Hamed Allahverdi
- Department of Biomedical and Clinical Sciences, Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", Università Di Milano, 20157, Milan, Italy
| | - Stella Papaleo
- Department of Biomedical and Clinical Sciences, Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", Università Di Milano, 20157, Milan, Italy
| | - Simona Panelli
- Department of Biomedical and Clinical Sciences, Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", Università Di Milano, 20157, Milan, Italy
| | - Sara Giordana Rimoldi
- Laboratorio di Microbiologia Clinica, Virologia e Diagnostica delle Bioemergenze, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Marta Corbella
- Department of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | | | - Paola Prati
- Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), Pavia, Italy
| | - Claudio Farina
- Laboratory of Microbiology and Virology, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Sciences, Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", Università Di Milano, 20157, Milan, Italy
- Department of Paediatrics, Children's Hospital "V. Buzzi", Milano, Italy
| | - Claudio Bandi
- Department of Biosciences and Pediatric Clinical Research Center "Romeo Ed Enrica Invernizzi", University of Milan, 20133, Milan, Italy
| | - Francesco Comandatore
- Department of Biomedical and Clinical Sciences, Pediatric Clinical Research Center "Romeo and Enrica Invernizzi", Università Di Milano, 20157, Milan, Italy.
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Morhart P, Gerlach RG, Kunz C, Held J, Valenza G, Wölfle J, Reutter H, Hanslik GJ, Fahlbusch FB. Application of Next-Generation Sequencing to Enterobacter Hormaechei Subspecies Analysis during a Neonatal Intensive Care Unit Outbreak. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1696. [PMID: 37892359 PMCID: PMC10605273 DOI: 10.3390/children10101696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION The Enterobacter cloacae complex (ECC) species are potential neonatal pathogens, and ECC strains are among the most commonly encountered Enterobacter spp. associated with nosocomial bloodstream infections. Outbreaks caused by ECC can lead to significant morbidity and mortality in susceptible neonates. At the molecular level, ECC exhibits genomic heterogeneity, with six closely related species and subspecies. Genetic variability poses a challenge in accurately identifying outbreaks by determining the clonality of ECC isolates. This difficulty is further compounded by the limitations of the commonly used molecular typing methods, such as pulsed field gel electrophoresis, which do not provide reliable accuracy in distinguishing between ECC strains and can lead to incorrect conclusions. Next-generation sequencing (NGS) offers superior resolution in determining strain relatedness. Therefore, we investigated the clinical pertinence of incorporating NGS into existing bundle measures to enhance patient management during an outbreak of ECC in a level-3 neonatal intensive care unit (NICU) in Germany. METHODS As the standard of care, all neonates on the NICU received weekly microbiological swabs (nasopharyngeal and rectal) and analysis of endotracheal secretion, where feasible. During the 2.5-month outbreak, colonisation with ECC was detected in n = 10 neonates. The phylogenetic relationship and potential antimicrobial resistance genes as well as mobile genetic elements were identified via bacterial whole-genome sequencing (WGS) using Illumina MiSeq followed by in silico data analysis. RESULTS Although all ECC isolates exhibited almost identical antimicrobial susceptibility patterns, the WGS data revealed the involvement of four different ECC clones. The isolates could be characterised as Enterobacter hormaechei subspecies steigerwaltii (n = 6, clonal), subsp. hoffmannii (n = 3, two clones) and subsp. oharae (n = 1). Despite the collection of environmental samples, no source of this diffuse outbreak could be identified. A new standardised operating procedure was implemented to enhance the management of neonates colonised with MRGN. This collaborative approach involved both parents and medical professionals and successfully prevented further transmission of ECC. CONCLUSIONS Initially, it was believed that the NICU outbreak was caused by a single ECC clone due to the similarity in antibiotic resistance. However, our findings show that antibiotic susceptibility patterns can be misleading in investigating outbreaks of multi-drug-resistant ECC. In contrast, bacterial WGS accurately identified ECC at the clonal level, which significantly helped to delineate the nature of the observed outbreak.
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Affiliation(s)
- Patrick Morhart
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (P.M.); (H.R.); (G.J.H.)
| | - Roman G. Gerlach
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Caroline Kunz
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Jürgen Held
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Giuseppe Valenza
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Joachim Wölfle
- Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Heiko Reutter
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (P.M.); (H.R.); (G.J.H.)
| | - Gregor J. Hanslik
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (P.M.); (H.R.); (G.J.H.)
| | - Fabian B. Fahlbusch
- Neonatology and Pediatric Intensive Care, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
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11
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Coggins SA, Edwards EM, Flannery DD, Gerber JS, Horbar JD, Puopolo KM. Serratia Infection Epidemiology Among Very Preterm Infants in the Neonatal Intensive Care Unit. Pediatr Infect Dis J 2023; 42:152-158. [PMID: 36638403 PMCID: PMC9846441 DOI: 10.1097/inf.0000000000003736] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Serratia spp. are opportunistic, multidrug resistant, Gram-negative pathogens, previously described among preterm infants in case reports or outbreaks of infection. We describe Serratia late-onset infection (LOI) in very preterm infants in a large, contemporary, nationally representative cohort. METHODS In this secondary analysis of prospectively collected data of preterm infants born 401-1500 grams and/or 22-29 weeks gestational age from 2018 to 2020 at 774 Vermont Oxford Network members, LOI was defined as culture-confirmed blood and/or cerebrospinal fluid infection > 3 days after birth. The primary outcome was incidence of Serratia LOI. Secondary outcomes compared rates of survival and discharge morbidities between infants with Serratia and non-Serratia LOI. RESULTS Among 119,565 infants, LOI occurred in 10,687 (8.9%). Serratia was isolated in 279 cases (2.6% of all LOI; 2.3 Serratia infections per 1000 infants). Of 774 hospitals, 161 (21%) reported at least one Serratia LOI; 170 of 271 (63%) cases occurred at hospitals reporting 1 or 2 Serratia infections, and 53 of 271 (20%) occurred at hospitals reporting ≥5 Serratia infections. Serratia LOI was associated with a lower rate of survival to discharge compared with those with non-Serratia LOI (adjusted relative risk 0.88, 95% CI: 0.82-0.95). Among survivors, infants with Serratia LOI had higher rates of tracheostomy, gastrostomy and home oxygen use compared with those with non-Serratia LOI. CONCLUSIONS The incidence of Serratia LOI was 2.3 infections per 1000 very preterm infants in this cohort. Lower survival and significant morbidity among Serratia LOI survivors highlight the need for recognition and targeted prevention strategies for this opportunistic nosocomial infection.
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Affiliation(s)
- Sarah A. Coggins
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
| | - Erika M. Edwards
- University of Vermont, Burlington, VT, USA
- Vermont-Oxford Network, Burlington, VT, USA
| | - Dustin D. Flannery
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jeffrey S. Gerber
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jeffrey D. Horbar
- University of Vermont, Burlington, VT, USA
- Vermont-Oxford Network, Burlington, VT, USA
| | - Karen M. Puopolo
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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12
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Piccirilli A, Cherubini S, Brisdelli F, Fazii P, Stanziale A, Di Valerio S, Chiavaroli V, Principe L, Perilli M. Molecular Characterization by Whole-Genome Sequencing of Clinical and Environmental Serratia marcescens Strains Isolated during an Outbreak in a Neonatal Intensive Care Unit (NICU). Diagnostics (Basel) 2022; 12:diagnostics12092180. [PMID: 36140580 PMCID: PMC9498040 DOI: 10.3390/diagnostics12092180] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/27/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
The whole-genome sequencing (WGS) of eighteen S. marcescens clinical strains isolated from 18 newborns hospitalized in the Neonatal Intensive Care Unit (NICU) at Pescara Public Hospital, Italy, was compared with that of S. marcescens isolated from cradles surfaces in the same ward. The identical antibiotic resistance genes (ARGs) and virulence factors were found in both clinical and environmental S. marcescens strains. The aac(6′)-Ic, tetA(41), blaSRT-3, adeFGH, rsmA, and PBP3 (D350N) genes were identified in all strains. The SRT-3 enzyme, which exhibited 10 amino acid substitutions with respect to SST-1, the constitutive AmpC β-lactamase in S. marcescens, was partially purified and tested against some β-lactams. It showed a good activity against cefazolin. Both clinical and environmental S. marcescens strains exhibited susceptibility to all antibiotics tested, with the exception of amoxicillin/clavulanate.
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Affiliation(s)
- Alessandra Piccirilli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Correspondence: (A.P.); (M.P.); Tel.: +39-0862433489 (M.P.)
| | - Sabrina Cherubini
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Fabrizia Brisdelli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Paolo Fazii
- Clinical Microbiology and Virology Unit, Pescara Public Hospital, 65122 Pescara, Italy
| | - Andrea Stanziale
- Clinical Microbiology and Virology Unit, Pescara Public Hospital, 65122 Pescara, Italy
| | - Susanna Di Valerio
- Neonatal Intensive Care Unit, Pescara Public Hospital, 65123 Pescara, Italy
| | - Valentina Chiavaroli
- Neonatal Intensive Care Unit, Pescara Public Hospital, 65123 Pescara, Italy
- Liggins Institute, The University of Auckland, Auckland 1141, New Zealand
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy
| | - Mariagrazia Perilli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Correspondence: (A.P.); (M.P.); Tel.: +39-0862433489 (M.P.)
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13
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Williams DJ, Grimont PAD, Cazares A, Grimont F, Ageron E, Pettigrew KA, Cazares D, Njamkepo E, Weill FX, Heinz E, Holden MTG, Thomson NR, Coulthurst SJ. The genus Serratia revisited by genomics. Nat Commun 2022; 13:5195. [PMID: 36057639 PMCID: PMC9440931 DOI: 10.1038/s41467-022-32929-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
The genus Serratia has been studied for over a century and includes clinically-important and diverse environmental members. Despite this, there is a paucity of genomic information across the genus and a robust whole genome-based phylogenetic framework is lacking. Here, we have assembled and analysed a representative set of 664 genomes from across the genus, including 215 historic isolates originally used in defining the genus. Phylogenomic analysis of the genus reveals a clearly-defined population structure which displays deep divisions and aligns with ecological niche, as well as striking congruence between historical biochemical phenotyping data and contemporary genomics data. We highlight the genomic, phenotypic and plasmid diversity of Serratia, and provide evidence of different patterns of gene flow across the genus. Our work provides a framework for understanding the emergence of clinical and other lineages of Serratia.
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Affiliation(s)
- David J Williams
- Division of Molecular Microbiology, School of Life Sciences, University of Dundee, Dundee, UK
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Patrick A D Grimont
- Unité Biodiversité des Bactéries Pathogènes Emergentes, INSERM Unité 389, Institut Pasteur, Paris, France
| | - Adrián Cazares
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, UK
| | - Francine Grimont
- Unité Biodiversité des Bactéries Pathogènes Emergentes, INSERM Unité 389, Institut Pasteur, Paris, France
| | - Elisabeth Ageron
- Unité Biodiversité des Bactéries Pathogènes Emergentes, INSERM Unité 389, Institut Pasteur, Paris, France
- Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker Enfants Malades, Paris, France
| | | | - Daniel Cazares
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Elisabeth Njamkepo
- Institut Pasteur, Université de Paris, Unité des Bactéries Pathogènes Entériques, Paris, France
| | - François-Xavier Weill
- Institut Pasteur, Université de Paris, Unité des Bactéries Pathogènes Entériques, Paris, France
| | - Eva Heinz
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Departments of Vector Biology and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Nicholas R Thomson
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK.
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Sarah J Coulthurst
- Division of Molecular Microbiology, School of Life Sciences, University of Dundee, Dundee, UK.
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Khan A, Anders A, Cardonell M. Neonatal Conjunctivitis. Neoreviews 2022; 23:e603-e612. [PMID: 36047752 DOI: 10.1542/neo.23-9-e603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Neonatal conjunctivitis is an important cause of ocular morbidity with infectious and noninfectious origins. Common practice in the United States is to administer prophylactic antibiotic ointment at birth; however, prophylaxis is ineffective for some causes. Moreover, recognition of the etiologies that threaten systemic complications to the neonate is critical in providing timely and appropriate treatment. This review summarizes the clinical features, etiology, and treatment recommendations of various forms of neonatal conjunctivitis.
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Affiliation(s)
- Azeem Khan
- Department of Ophthalmology, University of Missouri, Columbia, MO
| | - Anjali Anders
- Department of Pediatrics, University of Missouri, Columbia, MO
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15
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Howard-Jones AR, Janto C, Jennings Z, Branley J, Wang Q, Sintchenko V, Samarasekara H. Prompt control of a Serratia marcescens outbreak in a neonatal intensive care unit informed by whole-genome sequencing and comprehensive infection control intervention package. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e104. [PMID: 36483351 PMCID: PMC9726519 DOI: 10.1017/ash.2022.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This report describes a cluster of patients infected by Serratia marcescens in a metropolitan neonatal intensive care unit (NICU) and a package of infection control interventions that enabled rapid, effective termination of the outbreak. DESIGN Cross-sectional analytical study using whole-genome sequencing (WGS) for phylogenetic cluster analysis and identification of virulence and resistance genes. SETTING NICU in a metropolitan tertiary-care hospital in Sydney, Australia. PATIENTS All neonates admitted to the level 2 and level 3 neonatal unit. INTERVENTIONS Active inpatient and environmental screening for Serratia marcescens isolates with WGS analysis for identification of resistance genes as well as cluster relatedness between isolates. Planning and implementation of a targeted, multifaceted infection control intervention. RESULTS The cluster of 10 neonates colonized or infected with Serratia marcescens was identified in a metropolitan NICU. Two initial cases involved devastating intracranial infections with brain abscesses, highlighting the virulence of this organism. A targeted and comprehensive infection control intervention guided by WGS findings enabled termination of this outbreak within 15 days of onset. WGS examination demonstrated phylogenetic linkage across the cluster, and genomic unrelatedness of later strains identified in the neonatal unit and elsewhere. CONCLUSIONS A comprehensive, multipronged, infection control package incorporating close stakeholder engagement, frequent microbiological patient screening, environmental screening, enhanced cleaning, optimization of hand hygiene and healthcare worker education was paramount to the prompt control of Serratia marcescens transmission in this neonatal outbreak. WGS was instrumental in establishing relatedness between isolates and identification of possible transmission pathways in an outbreak setting.
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Affiliation(s)
- Annaleise R. Howard-Jones
- New South Wales Health Pathology-Nepean, Penrith, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine Janto
- New South Wales Health Pathology-Nepean, Penrith, New South Wales, Australia
| | - Zoe Jennings
- Department of Microbiology and Infectious Diseases, Nepean Hospital, Kingswood, New South Wales, Australia
| | - James Branley
- New South Wales Health Pathology-Nepean, Penrith, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Department of Microbiology and Infectious Diseases, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Qinning Wang
- Centre for Infectious Diseases & Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology & Medical Research, Westmead, New South Wales, Australia
| | - Vitali Sintchenko
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Centre for Infectious Diseases & Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology & Medical Research, Westmead, New South Wales, Australia
| | - Harsha Samarasekara
- New South Wales Health Pathology-Nepean, Penrith, New South Wales, Australia
- Department of Microbiology and Infectious Diseases, Nepean Hospital, Kingswood, New South Wales, Australia
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16
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Millán-Lou MI, López C, Bueno J, Pérez-Laguna V, Lapresta C, Fuertes ME, Rite S, Santiago M, Romo M, Samper S, Cebollada A, Oteo-Iglesias J, Rezusta A. Successful control of Serratia marcescens outbreak in a neonatal unit of a tertiary-care hospital in Spain. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:248-254. [PMID: 35577443 DOI: 10.1016/j.eimce.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/06/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Serratia marcescens is a Gram-negative bacterium that is found in hospital environments and commonly associated with outbreaks in neonatal units. One S. marcescens isolate was detected from a bloodstream culture from a neonate in our hospital that was followed by an outbreak. The aim of this study was to describe the molecular epidemiology of a S. marcescens outbreak in the neonatal unit. METHODS In order to investigate the outbreak, weekly surveillance rectal swabs were submitted for culture from all patients admitted in this unit from August to September 2018. Environmental samples were obtained from potential sources in September 2018. Typing of isolates was performed by pulsed field gel electrophoresis (PFGE). In addition, we studied the in vitro activity of chlorhexidine against S. marcescens. RESULTS During this period, 146 infants were hospitalised in our neonatal unit, of which 16 patients had a S. marcescens-positive sample. A total of 36 environmental surveillance samples were collected, and one sample from a stethoscope from an incubator of a colonized baby was positive for S. marcescens. All the 18 isolates, including the isolate from the stethoscope, belonged to a single PFGE cluster. We found that very low concentrations of chlorhexidine, even with application times close to 0 achieved significant reductions in the amount of S. marcescens. CONCLUSION A unique clone of S. marcescens caused this outbreak, including isolates from patients and from one stethoscope. The outbreak was controlled with the early implementation of specific control measures.
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Affiliation(s)
- María Isabel Millán-Lou
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
| | - Concepción López
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Jessica Bueno
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Vanesa Pérez-Laguna
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
| | - Carlos Lapresta
- Servicio de Medicina Preventiva, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - María Elena Fuertes
- Unidad de neonatología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Segundo Rite
- Unidad de neonatología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Mónica Santiago
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - María Romo
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Sofia Samper
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Alberto Cebollada
- CIBERES, ISCIII, Madrid, Spain; Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain; Unidad de Biocomputación, Instituto Aragonés de Ciencias de la Salud (IACS/IIS Aragón), Zaragoza, Spain
| | - Jesús Oteo-Iglesias
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Rezusta
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain
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17
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van der Hoeven A, Bekker V, Jansen SJ, Saccoccia B, Berkhout RJM, Lopriore E, Veldkamp KE, van der Beek MT. Impact of transition from open bay to single room design NICU on MDRO colonization rates. J Hosp Infect 2021; 120:90-97. [PMID: 34902498 DOI: 10.1016/j.jhin.2021.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The influence of the neonatal intensive care unit (NICU) design on the acquisition of multidrug resistant organisms (MDRO) has not been well-documented. AIM To examine the effect of single room unit (SRU) versus open bay unit (OBU) design on the incidence of colonization with MDRO and third-generation cephalosporin resistant bacteria (3G-CRB) in infants admitted to the NICU. METHODS Retrospective cohort study, including all infants admitted to the NICU of a tertiary care academic hospital two years prior to and two years following the transition from OBU to SRU in May 2017. Weekly cultures of throat and rectum were collected to screen for MDRO carriership. Incidence of colonization (percentage of all infants and incidence density per 1,000 patient-days) with MDRO and 3G-CRB were compared between OBU and SRU periods. FINDINGS Incidence analysis of 1,293 NICU infants, identified 3.2% MDRO carriers (2.5% OBU, 4.0% SRU, n.s.), including 2.3% extended-spectrum β-lactamase producing Enterobacterales carriers, and 18.6% 3G-CRB carriers (17% OBU, 20% SRU, n.s.). No differences were found in MDRO incidence density per 1,000 patient-days between infants admitted to OBU (1.56) compared to SRU infants (2.63). CONCLUSION Transition in NICU design from open bay to single room units was not associated with a reduction in colonization rates with MDRO or 3G-CRB in our hospital. Further research on preventing the acquisition and spread of resistant bacteria at high-risk departments such as the NICU, as well as optimal ward design, are needed.
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Affiliation(s)
- Alieke van der Hoeven
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Vincent Bekker
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital - Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Sophie J Jansen
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital - Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Barbara Saccoccia
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital - Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Romy J M Berkhout
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital - Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital - Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martha T van der Beek
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
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A Genome-Scale Antibiotic Screen in Serratia marcescens Identifies YdgH as a Conserved Modifier of Cephalosporin and Detergent Susceptibility. Antimicrob Agents Chemother 2021; 65:e0078621. [PMID: 34491801 DOI: 10.1128/aac.00786-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Serratia marcescens, a member of the order Enterobacterales, is adept at colonizing health care environments and is an important cause of invasive infections. Antibiotic resistance is a daunting problem in S. marcescens because, in addition to plasmid-mediated mechanisms, most isolates have considerable intrinsic resistance to multiple antibiotic classes. To discover endogenous modifiers of antibiotic susceptibility in S. marcescens, a high-density transposon insertion library was subjected to sub-MICs of two cephalosporins, cefoxitin, and cefepime, as well as the fluoroquinolone ciprofloxacin. Comparisons of transposon insertion abundance before and after antibiotic exposure identified hundreds of potential modifiers of susceptibility to these agents. Using single-gene deletions, we validated several candidate modifiers of cefoxitin susceptibility and chose ydgH, a gene of unknown function, for further characterization. In addition to cefoxitin, deletion of ydgH in S. marcescens resulted in decreased susceptibility to multiple third-generation cephalosporins and, in contrast, to increased susceptibility to both cationic and anionic detergents. YdgH is highly conserved throughout the Enterobacterales, and we observed similar phenotypes in Escherichia coli O157:H7 and Enterobacter cloacae mutants. YdgH is predicted to localize to the periplasm, and we speculate that it may be involved there in cell envelope homeostasis. Collectively, our findings provide insight into chromosomal mediators of antibiotic resistance in S. marcescens and will serve as a resource for further investigations of this important pathogen.
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A Possible Outbreak by Serratia marcescens: Genetic Relatedness between Clinical and Environmental Strains. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189814. [PMID: 34574734 PMCID: PMC8472797 DOI: 10.3390/ijerph18189814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
Serratia marcescens (SM) is a Gram-negative bacterium that is frequently found in the environment. Since 1913, when its pathogenicity was first demonstrated, the number of infections caused by SM has increased. There is ample evidence that SM causes nosocomial infections in immunocompromised or critically ill patients admitted to the intensive care units (ICUs), but also in newborns admitted to neonatal ICUs (NICUs). In this study, we evaluated the possible genetic correlation by PFGE between clinical and environmental SM strains from NICU and ICU and compared the genetic profile of clinical strains with strains isolated from patients admitted to other wards of the same hospital. We found distinct clonally related groups of SM strains circulating among different wards of a large university hospital. In particular, the clonal relationship between clinical and environmental strains in NICU and ICU 1 was highlighted. The identification of clonal relationships between clinical and environmental strains in the wards allowed identification of the epidemic and rapid implementation of adequate measures to stop the spread of SM.
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20
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Millán-Lou MI, López C, Bueno J, Pérez-Laguna V, Lapresta C, Fuertes ME, Rite S, Santiago M, Romo M, Samper S, Cebollada A, Oteo-Iglesias J, Rezusta A. Successful control of Serratia marcescens outbreak in a neonatal unit of a tertiary-care hospital in Spain. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00186-5. [PMID: 34144851 DOI: 10.1016/j.eimc.2021.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Serratia marcescens is a Gram-negative bacterium that is found in hospital environments and commonly associated with outbreaks in neonatal units. One S. marcescens isolate was detected from a bloodstream culture from a neonate in our hospital that was followed by an outbreak. The aim of this study was to describe the molecular epidemiology of a S. marcescens outbreak in the neonatal unit. METHODS In order to investigate the outbreak, weekly surveillance rectal swabs were submitted for culture from all patients admitted in this unit from August to September 2018. Environmental samples were obtained from potential sources in September 2018. Typing of isolates was performed by pulsed field gel electrophoresis (PFGE). In addition, we studied the in vitro activity of chlorhexidine against S. marcescens. RESULTS During this period, 146 infants were hospitalised in our neonatal unit, of which 16 patients had a S. marcescens-positive sample. A total of 36 environmental surveillance samples were collected, and one sample from a stethoscope from an incubator of a colonized baby was positive for S. marcescens. All the 18 isolates, including the isolate from the stethoscope, belonged to a single PFGE cluster. We found that very low concentrations of chlorhexidine, even with application times close to 0 achieved significant reductions in the amount of S. marcescens. CONCLUSION A unique clone of S. marcescens caused this outbreak, including isolates from patients and from one stethoscope. The outbreak was controlled with the early implementation of specific control measures.
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Affiliation(s)
- María Isabel Millán-Lou
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
| | - Concepción López
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Jessica Bueno
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Vanesa Pérez-Laguna
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
| | - Carlos Lapresta
- Servicio de Medicina Preventiva, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - María Elena Fuertes
- Unidad de neonatología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Segundo Rite
- Unidad de neonatología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Mónica Santiago
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - María Romo
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain
| | - Sofia Samper
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Alberto Cebollada
- CIBERES, ISCIII, Madrid, Spain; Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain; Unidad de Biocomputación, Instituto Aragonés de Ciencias de la Salud (IACS/IIS Aragón), Zaragoza, Spain
| | - Jesús Oteo-Iglesias
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Rezusta
- Servicio de Microbiología, Hospital Universitario Miguel-Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain
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21
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Böhne C, Chhatwal P, Peter C, Ebadi E, Hansen G, Schlüter D, Bange FC, Bohnhorst B, Baier C. Detection of Serratia marcescens in neonatal intensive care units requires a rapid and comprehensive infection control response starting with the very first case. GMS HYGIENE AND INFECTION CONTROL 2021; 16:Doc12. [PMID: 33796440 PMCID: PMC7983028 DOI: 10.3205/dgkh000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Serratia marcescens is a well-known and challenging pathogen in neonatal intensive care units. It is responsible for severe infections and can cause nosocomial outbreaks. Methods: We present the infection control response to a Serratia marcescens cluster which occurred in a tertiary neonatal intensive care unit. Results and conclusions: The presented comprehensive and decisive hygiene management response starting with the very first case aims especially at early detection and immediate interruption of nosocomial transmission. Frequent and sensitive microbiological screening, rigorous spatial isolation of colonized infants, and reinforcing adherence to hand hygiene are essential in this response, which comprises eight measures. It prevented a full-blown outbreak.
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Affiliation(s)
- Carolin Böhne
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Patrick Chhatwal
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Corinna Peter
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Ella Ebadi
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Dirk Schlüter
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Franz-Christoph Bange
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Bettina Bohnhorst
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Claas Baier
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany,*To whom correspondence should be addressed: Claas Baier, Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany, Phone: +49 511 532 8675, Fax: +49 511 532 8174, E-mail:
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22
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Muyldermans A, Crombé F, Bosmans P, Cools F, Piérard D, Wybo I. Serratia marcescens outbreak in a neonatal intensive care unit and the potential of whole-genome sequencing. J Hosp Infect 2021; 111:148-154. [PMID: 33581246 DOI: 10.1016/j.jhin.2021.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Serratia marcescens is notorious for its increasing antimicrobial resistance and potential to cause outbreaks in neonatal intensive care units (NICUs). A promising tool in outbreak investigations is whole-genome sequencing (WGS). OBJECTIVES To describe a S. marcescens outbreak (2018-2019) in an NICU and discuss which infection control measures contributed to containment, addressing the potential of WGS. METHODS S. marcescens isolates from patients and the environment isolated during the 2018-2019 NICU outbreak were analysed. In comparison, isolates from previous presumed NICU outbreaks and adult blood cultures were included. WGS and whole-genome multi-locus sequence typing analysis were performed. RESULTS Sixty-three S. marcescens isolates were analysed. The 2018-2019 outbreak was divided into three clusters, including four environmental strains (drains, N=3; baby scale, N=1). The strains differed significantly from those of an NICU outbreak in 2014 and adult blood cultures. Besides standard infection control measures, the siphons were replaced and weekly decontamination was performed with acetic acid 10%. Seven acquired-resistance genes and 29 virulence-associated genes were detected. CONCLUSIONS It was assumed that both neonates and drains were reservoirs of S. marcescens cross-contamination via the hands of healthcare workers and parents. Initially, standard measures, including hand hygiene, were reinforced. However, definitive containment was achieved only after replacement of the siphons and weekly decontamination with acetic acid. WGS enables faster recognition of an outbreak with accurate mapping of the spread, facilitating the implementation of infection control measures. WGS also provides interesting information about the spread of antibiotic resistance and virulence genes.
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Affiliation(s)
- A Muyldermans
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - F Crombé
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - P Bosmans
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - F Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - D Piérard
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - I Wybo
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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23
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Whole-genome sequencing for neonatal intensive care unit outbreak investigations: Insights and lessons learned. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2021; 1:e2. [PMID: 36168459 PMCID: PMC9495531 DOI: 10.1017/ash.2021.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/20/2022]
Abstract
Abstract
Infectious diseases outbreaks are a cause of significant morbidity and mortality among hospitalized patients. Infants admitted to the neonatal intensive care unit (NICU) are particularly vulnerable to infectious complications during hospitalization. Thus, rapid recognition of and response to outbreaks in the NICU is essential. At Rush University Medical Center, whole-genome sequencing (WGS) has been utilized since early 2016 as an adjunctive method for outbreak investigations. The use of WGS and potential lessons learned are illustrated for 3 different NICU outbreak investigations involving methicillin-resistant Staphylococcus aureus (MRSA), group B Streptococcus (GBS), and Serratia marcescens. WGS has contributed to the understanding of the epidemiology of outbreaks in our NICU, and it has also provided further insight in settings of unusual diseases or when lower-resolution typing methods have been inadequate. WGS has emerged as the new gold standard for evaluating strain relatedness. As barriers to implementation are overcome, WGS has the potential to transform outbreak investigation in healthcare settings.
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24
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Yuan P, Jiang X, Wang S, Shao X, Yang Q, Qian X. X-ray Structure and Molecular Docking Guided Discovery of Novel Chitinase Inhibitors with a Scaffold of Dipyridopyrimidine-3-carboxamide. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2020; 68:13584-13593. [PMID: 33151676 DOI: 10.1021/acs.jafc.0c03742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chitinases are the glycosyl hydrolase for catalyzing the degradation of chitin and play an indispensable role in bacterial pathogenesis, fungal cell wall remodeling, and insect molting. Thus, chitinases are attractive targets for therapeutic drugs and pesticides. Here, we present a strategy of developing a novel chemotype of chitinase inhibitors by the construction of planar heterocycles that can stack with conserved aromatic residues. The rational design, guided by crystallographic analysis and docking results, leads to a series of dipyridopyrimidine-3-carboxamide derivatives as chitinase inhibitors. Among them, compound 6t showed the most potent activity against bacterial chitinase SmChiB and insect chitinase OfChi-h, with a Ki value of 0.14 and 0.0056 μM, respectively. The strong stacking interaction of compound 6p with Trp99 and Trp220 found in the SmChiB-6p co-crystal structure verifies the feasibility of our design. Our results provide novel insights into developing potent chitinase inhibitors for pathogen and pest control.
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Affiliation(s)
- Pengtao Yuan
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, People's Republic of China
| | - Xi Jiang
- Guangdong Laboratory for Lingnan Modern Agriculture (Shenzhen Branch), Agricultural Genomics Institute at Shenzhen, Chinese Academy of Agricultural Sciences, 7 Pengfei Road, Shenzhen 518120, People's Republic of China
| | - Siyu Wang
- Guangdong Laboratory for Lingnan Modern Agriculture (Shenzhen Branch), Agricultural Genomics Institute at Shenzhen, Chinese Academy of Agricultural Sciences, 7 Pengfei Road, Shenzhen 518120, People's Republic of China
| | - Xusheng Shao
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, People's Republic of China
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai 200237, People's Republic of China
| | - Qing Yang
- Guangdong Laboratory for Lingnan Modern Agriculture (Shenzhen Branch), Agricultural Genomics Institute at Shenzhen, Chinese Academy of Agricultural Sciences, 7 Pengfei Road, Shenzhen 518120, People's Republic of China
| | - Xuhong Qian
- Shanghai Key Laboratory of Chemical Biology, School of Pharmacy, East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, People's Republic of China
- State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai 200237, People's Republic of China
- School of Chemistry and Molecular Engineering, East China Normal University, Shanghai 200241, People's Republic of China
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25
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Ferreira RL, Rezende GS, Damas MSF, Oliveira-Silva M, Pitondo-Silva A, Brito MCA, Leonardecz E, de Góes FR, Campanini EB, Malavazi I, da Cunha AF, Pranchevicius MCDS. Characterization of KPC-Producing Serratia marcescens in an Intensive Care Unit of a Brazilian Tertiary Hospital. Front Microbiol 2020; 11:956. [PMID: 32670210 PMCID: PMC7326048 DOI: 10.3389/fmicb.2020.00956] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
Serratia marcescens has emerged as an important opportunistic pathogen responsible for nosocomial and severe infections. Here, we determined phenotypic and molecular characteristics of 54 S. marcescens isolates obtained from patient samples from intensive-care-unit (ICU) and neonatal intensive-care-unit (NIUC) of a Brazilian tertiary hospital. All isolates were resistant to beta-lactam group antibiotics, and 92.6% (50/54) were not susceptible to tigecycline. Furthermore, 96.3% showed intrinsic resistance to polymyxin E (colistin), a last-resort antibiotic for the treatment of infections caused by MDR (multidrug-resistant) Gram-negative bacteria. In contrast, high susceptibility to other antibiotics such as fluoroquinolones (81.5%), and to aminoglycosides (as gentamicin 81.5%, and amikacin 85.2%) was found. Of all isolates, 24.1% were classified as MDR. The presence of resistance and virulence genes were examined by PCR and sequencing. All isolates carried KPC-carbapenemase (blaKPC) and extended spectrum beta-lactamase blaTEM genes, 14.8% carried blaOXA–1, and 16.7% carried blaCTX–M–1group genes, suggesting that bacterial resistance to β-lactam antibiotics found may be associated with these genes. The genes SdeB/HasF and SdeY/HasF that are associated with efflux pump mediated drug extrusion to fluoroquinolones and tigecycline, respectively, were found in 88.9%. The aac(6′)-Ib-cr variant gene that can simultaneously induce resistance to aminoglycoside and fluoroquinolone was present in 24.1% of the isolates. Notably, the virulence genes to (i) pore-forming toxin (ShlA); (ii) phospholipase with hemolytic and cytolytic activities (PhlA); (iii) flagellar transcriptional regulator (FlhD); and (iv) positive regulator of prodigiosin and serratamolide production (PigP) were present in 98.2%. The genetic relationship among the isolates determined by ERIC-PCR demonstrated that the vast majority of isolates were grouped in a single cluster with 86.4% genetic similarity. In addition, many isolates showed 100% genetic similarity to each other, suggesting that the S. marcescens that circulate in this ICU are closely related. Our results suggest that the antimicrobial resistance to many drugs currently used to treat ICU and NIUC patients, associated with the high frequency of resistance and virulence genes is a worrisome phenomenon. Our findings emphasize the importance of active surveillance plans for infection control and to prevent dissemination of these strains.
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Affiliation(s)
- Roumayne L Ferreira
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Graziela S Rezende
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | - Mariana Oliveira-Silva
- Programas de Pós-graduação em Odontologia e Tecnologia Ambiental, Universidade de Ribeirão Preto, Ribeirão Preto, Brazil
| | - André Pitondo-Silva
- Programas de Pós-graduação em Odontologia e Tecnologia Ambiental, Universidade de Ribeirão Preto, Ribeirão Preto, Brazil
| | - Márcia C A Brito
- Laboratório Central de Saúde Pública do Tocantins, Palmas, Brazil
| | - Eduardo Leonardecz
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Fabiana R de Góes
- Instituto de Ciências Matemáticas e de Computação, Universidade de São Paulo, São Carlos, Brazil
| | - Emeline Boni Campanini
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Iran Malavazi
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Anderson F da Cunha
- Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
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26
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Saralegui C, Ponce-Alonso M, Pérez-Viso B, Moles Alegre L, Escribano E, Lázaro-Perona F, Lanza VF, de Pipaón MS, Rodríguez JM, Baquero F, Del Campo R. Genomics of Serratia marcescens Isolates Causing Outbreaks in the Same Pediatric Unit 47 Years Apart: Position in an Updated Phylogeny of the Species. Front Microbiol 2020; 11:451. [PMID: 32296400 PMCID: PMC7136904 DOI: 10.3389/fmicb.2020.00451] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/02/2020] [Indexed: 12/16/2022] Open
Abstract
The first documented nosocomial outbreak caused by Serratia marcescens in Spain occurred in 1969 at the neonatal intensive care unit (NICU) of the tertiary La Paz Children's Hospital in Madrid, Spain, and based on the available phenotyping techniques at this time, it was considered as a monoclonal outbreak. Only 47 years later, another S. marcescens outbreak of an equivalent dimension occurred at the same NICU. The aim of the present study was to study isolates from these historical and contemporary outbreaks by phenotypic analysis and whole-genome sequencing techniques and to position these strains along with 444 publicly available S. marcescens genomes, separately comparing core genome and accessory genome contents. Clades inferred by both approaches showed high correlation, indicating that core and accessory genomes seem to evolve in the same manner for S. marcescens. Nine S. marcescens clusters were identified, and isolates were grouped in two of them according to sampling year. One exception was isolate 13F-69, the most genetically distant strain, located in a different cluster. Categorical functions in the annotated accessory genes of both collections were preserved among all isolates. No significant differences in frequency of insertion sequences in historical (0.18-0.20)-excluding the outlier strain-versus contemporary isolates (0.11-0.19) were found despite the expected resting effect. The most dissimilar isolate, 13F-69, contains a highly preserved plasmid previously described in Bordetella bronchiseptica. This strain exhibited a few antibiotic resistance genes not resulting in a resistant phenotype, suggesting the value of gene down expression in adaptation to long-term starvation.
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Affiliation(s)
- Claudia Saralegui
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.,Red Española de Investigación en Patología Infecciosa, Madrid, Spain
| | - Manuel Ponce-Alonso
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.,Red Española de Investigación en Patología Infecciosa, Madrid, Spain
| | - Blanca Pérez-Viso
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Laura Moles Alegre
- Unidad de Esclerosis Múltiple, Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | - Esperanza Escribano
- Servicio de Neonatología, Hospital Universitario La Paz, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Val F Lanza
- Unidad de Bioinformática del IRYCIS, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Miguel Sáenz de Pipaón
- Servicio de Neonatología, Hospital Universitario La Paz, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan Miguel Rodríguez
- Departamento de Nutrición y Ciencia de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
| | - Fernando Baquero
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Rosa Del Campo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.,Red Española de Investigación en Patología Infecciosa, Madrid, Spain
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27
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Bielli A, Piazza A, Cento V, Comandatore F, Lepera V, Gatti M, Brioschi P, Vismara C, Bandi C, Perno CF. In vivo acquisition and risk of inter-species spread of bla KPC-3-plasmid from Klebsiella pneumoniae to Serratia marcescens in the lower respiratory tract. J Med Microbiol 2020; 69:82-86. [PMID: 31904319 DOI: 10.1099/jmm.0.001113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In recent years, Serratia marcescens has emerged as an important agent of hospital-acquired infections, such as pneumonia, urinary tract infection, septicaemia and meningitis, particularly in vulnerable patients. Compared to Klebsiella pneumoniae and Escherichia coli, S. marcescens is less commonly associated with bla KPC genes, yet few cases of plasmid transmission at the gastrointestinal level from K. pneumoniae carbapenemase (KPC)-producing Enterobacterales to S. marcescens have been described. Here we report a case of in vivo acquisition, during a 3-month period of hospitalization in the intensive care unit, of a bla KPC-3 gene carried by a pKpQIL-IT plasmid, and its probable transmission at the bronchial level among different species of Enterobacterales, including K. pneumoniae and S. marcescens. By using whole genome sequence analyses we were able provide insight into the dynamics of carbapenem-resistance determinants acquisition in the lower respiratory tract, a novel anatomical region for such plasmid transmission events, that usually involve the gastrointestinal tract. The co-presence at the same time of both wild-type and resistant Enterobacterales could have been the critical factor leading to the spread of plasmids harbouring carbapenem-resistance genes, of particular importance during surveillance screenings. The possibility of such an event may have significant consequences in terms of antimicrobial treatment, with a potential limitation of therapeutic options, thereby further complicating the clinical management of high-risk critically ill patients.
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Affiliation(s)
- Alessandra Bielli
- Chemical-Clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Aurora Piazza
- Romeo and Enrica Invernizzi Pediatric Research Center, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Valeria Cento
- Residency in Microbiology and Virology, Università degli Studi di Milano, Milan, Italy
| | - Francesco Comandatore
- Romeo and Enrica Invernizzi Pediatric Research Center, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Valentina Lepera
- Chemical-Clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Milo Gatti
- Anesthesiology and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Brioschi
- Anesthesiology and Intensive Care 1, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Vismara
- Chemical-Clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Claudio Bandi
- Biosciences Department, Università degli Studi di Milano, Milan, Italy.,Romeo and Enrica Invernizzi Pediatric Research Center, Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Carlo Federico Perno
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy.,Chemical-Clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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28
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Serratia marcescens in the neonatal intensive care unit: A cluster investigation using molecular methods. J Infect Public Health 2019; 13:1006-1011. [PMID: 31883745 DOI: 10.1016/j.jiph.2019.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/21/2019] [Accepted: 12/05/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Serratia marcescens (S. marcescens) is associated with nosocomial infections with significant morbidity and mortality in the neonatal intensive care units (NICU). We describe the control of a multi-clonal S. marcescens infections outbreak in our tertiary-level NICU and the application of molecular typing using repetitive element palindromic PCR (rep-PCR) and next generation sequencing (NGS) in the investigation. METHODS Outbreak investigation was performed where clinical, spatial and epidemiologic links were established. Screening of all infants in the NICU and the environment was performed. Rep-PCR and NGS methods were used to identify potential environmental sources of infections and clustering among cases. RESULTS Eleven cases were detected during the outbreak period: mean gestational age 27 weeks (range: 24-32), predominantly male (82%), mean age of infection 24 days (range: 6-51). Six infants were treated for conjunctivitis and one for bacteraemia. Identification of colonized infant via a point prevalence survey and cohorting of all infected/colonized patients were implemented. We performed environmental swabbing of surfaces, water outlets, chlorhexidine hand wash solutions and hand hygiene hand rubs. Both rep-PCR and NGS classified the 11 case isolates into 5 types. No point source was identified except for a single positive environmental isolate from a sink which was clonally distinct from the cases. CONCLUSION Identification and cohorting of infected/colonized patient was important in the control of S. marcescens outbreak in the NICU. The utility of rep-PCR was comparable to NGS in providing molecular information to develop S. marcescens outbreak control strategies.
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Iovene MR, Pota V, Galdiero M, Corvino G, Lella FMD, Stelitano D, Passavanti MB, Pace MC, Alfieri A, Franco SD, Aurilio C, Sansone P, Niyas VKM, Fiore M. First Italian outbreak of VIM-producing Serratia marcescensin an adult polyvalent intensive care unit, August-October 2018: A case report and literature review. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i21.3518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Iovene MR, Pota V, Galdiero M, Corvino G, Di Lella FM, Stelitano D, Passavanti MB, Pace MC, Alfieri A, Di Franco S, Aurilio C, Sansone P, Niyas VKM, Fiore M. First Italian outbreak of VIM-producing Serratia marcescens in an adult polyvalent intensive care unit, August-October 2018: A case report and literature review. World J Clin Cases 2019; 7:3535-3548. [PMID: 31750335 PMCID: PMC6854422 DOI: 10.12998/wjcc.v7.i21.3535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/15/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae has become a significant public health concern as hospital outbreaks are now being frequently reported and these organisms are becoming difficult to treat with the available antibiotics. CASE SUMMARY An outbreak of VIM-producing Serratia marcescens occurred over a period of 11 wk (August, 1 to October, 18) in patients admitted to the adult polyvalent intensive care unit of the University of Campania "Luigi Vanvitelli" located in Naples. Four episodes occurred in three patients (two patients infected, and one patient colonized). All the strains revealed the production of VIM. CONCLUSION After three decades of carbapenem antibiotics use, the emergence of carbapenem-resistance in Enterobacteriaceae has become a significant concern and a stricter control to preserve its clinical application is mandatory. This is, to our knowledge, the first outbreak of VIM-producing Serratia marcescens in Europe. Surveillance policies must be implemented to avoid future outbreaks.
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Affiliation(s)
- Maria Rosaria Iovene
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Vincenzo Pota
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Massimiliano Galdiero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Giusy Corvino
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Federica Maria Di Lella
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Debora Stelitano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Maria Beatrice Passavanti
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Aniello Alfieri
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Sveva Di Franco
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Caterina Aurilio
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Pasquale Sansone
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | | | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
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Moles L, Gómez M, Moroder E, Jiménez E, Escuder D, Bustos G, Melgar A, Villa J, Del Campo R, Chaves F, Rodríguez JM. Serratia marcescens colonization in preterm neonates during their neonatal intensive care unit stay. Antimicrob Resist Infect Control 2019; 8:135. [PMID: 31413826 PMCID: PMC6688303 DOI: 10.1186/s13756-019-0584-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 07/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background Nosocomial sepsis is the main problem that preterms have to face during their stay at neonatal intensive care units (NICU). Serratia marcescens is an emerging cause of preterm sepsis but its epidemiology is still largely unknown. Consequently, the aims of this study were to know the rate of preterms colonized by S. marcescens during their stay at the NICU and the characteristics and evolution of the S. marcescens population, including the susceptibility to clinically relevant antibiotics. Methods Twenty-six preterm infants born with a gestational age ≤ 32 weeks and/or weigh ≤1500 g were included in the study. Samples of meconium and feces (n = 92) were collected during their first month of life of the infants, together with feeding samples after their pass through enteral feeding tubes (n = 37). Samples were inoculated on MacConkey agar plates. The isolates identified as S. marcescens were genotyped using RAPD and PFGE; and antibiotics susceptibility was performed in a Vitek 2 system. Results A total of 179 S. marcescens isolates were obtained from the samples. PFGE profiling and cluster analysis allowed the classification of the isolates into 7 different S. marcescens clones. PFGE patterns 1 and 3 were the dominant strains in the fecal samples colonizing 31 and 35% of the infants, respectively. Those isolates causing bacteremia in two infants clustered in PFGE pattern 3. Conclusion S. marcescens is a bacterial species closely associated to the NICU environment. It can be frequently isolated from preterm’s feces although only some genetic lineages seem to be associated to sepsis. Enteral feeding tubes act as important reservoirs to keep the S. marcescens population in the NICU. Trial registration The local ethic committee approved this trial with the reference 09/157.
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Affiliation(s)
- Laura Moles
- 1Department of Nutrition and Food Science, Complutense University of Madrid, Avda. Puerta de Hierro, s/n, 28040 Madrid, Spain
| | - Marta Gómez
- 1Department of Nutrition and Food Science, Complutense University of Madrid, Avda. Puerta de Hierro, s/n, 28040 Madrid, Spain.,Servicio de Pediatría Hospital Francesc de Borja, Gandía, Valencia, Spain
| | - Elena Moroder
- 1Department of Nutrition and Food Science, Complutense University of Madrid, Avda. Puerta de Hierro, s/n, 28040 Madrid, Spain
| | - Esther Jiménez
- 1Department of Nutrition and Food Science, Complutense University of Madrid, Avda. Puerta de Hierro, s/n, 28040 Madrid, Spain
| | - Diana Escuder
- 3Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gerardo Bustos
- 3Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain.,4Red de Salud Materno-Infantil y del Desarrollo (SAMID), Instituto Carlos III, Madrid, Spain
| | - Ana Melgar
- 3Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain.,4Red de Salud Materno-Infantil y del Desarrollo (SAMID), Instituto Carlos III, Madrid, Spain
| | - Jeniffer Villa
- 5Servicio de Microbiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rosa Del Campo
- 6Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigaciones Sanitarias, Madrid, Spain
| | - Fernando Chaves
- 5Servicio de Microbiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan M Rodríguez
- 1Department of Nutrition and Food Science, Complutense University of Madrid, Avda. Puerta de Hierro, s/n, 28040 Madrid, Spain
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Underestimated Risks of Infantile Infectious Disease from the Caregiver's Typical Handling Practices of Infant Formula. Sci Rep 2019; 9:9799. [PMID: 31278304 PMCID: PMC6611816 DOI: 10.1038/s41598-019-46181-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/25/2019] [Indexed: 11/11/2022] Open
Abstract
The impact on infant caregiver as a reservoir of pathogens has not been exploited with perspective to powdered infant formula (PIF). Here we reveal novel route of pathogen transfer through hand-spoon-PIF unexpectedly occurred by even typical practices of caregivers, handling of PIF and storage of feeding-spoon in PIF container. Hand-spoon-PIF contamination route was simulated to analyze the transfer and subsequent survival of pathogens. Major pathogens associated with infantile fatal diseases (Cronobacter sakazakii, Salmonella enterica, Staphylococcus aureus) were readily transmitted to PIF from skin (3−6 log CFU/hand) via spoons following long-term survival of transferred pathogens (3 weeks; use-by date of PIF) as the excessive level of infectious dose, highlighting direct onset of diseases. Low bacterial load on skin (ca. 1 log CFU/hand) could prevent cross-contamination of PIF, however, at least 72 h survival of transferred pathogen on spoons demonstrated the probability on re-contamination of PIF. To our knowledge, this is the first study to investigate the cross-contamination of utensils in contact with powdered-foods. Bacterial load on hands is the key determinant of pathogen transfer and the extent of risk are species-dependent. These evidential results redefine risk of caregivers’ practices and facilitate incorporation of cross-contamination into risk-assessment as underestimated route of infection.
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Escribano E, Saralegui C, Moles L, Montes MT, Alba C, Alarcón T, Lázaro-Perona F, Rodríguez JM, Sáenz de Pipaón M, Del Campo R. Influence of a Serratia marcescens outbreak on the gut microbiota establishment process in low-weight preterm neonates. PLoS One 2019; 14:e0216581. [PMID: 31112570 PMCID: PMC6529157 DOI: 10.1371/journal.pone.0216581] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 04/25/2019] [Indexed: 02/07/2023] Open
Abstract
Adequate gut microbiota establishment is important for lifelong health. The aim was to sequentially analyze the gut microbiota establishment in low-birth-weight preterm neonates admitted to a single neonatal intensive care unit during their first 3 weeks of life, comparing two epidemiological scenarios. Seven control infants were recruited, and another 12 during a severe S. marcescens outbreak. Meconium and feces from days 7, 14, and 21 of life were collected. Gut microbiota composition was determined by 16S rDNA massive sequencing. Cultivable isolates were genotyped by pulsed-field gel electrophoresis, with four S. marcescens submitted for whole-genome sequencing. The expected bacterial ecosystem expansion after birth is delayed, possibly related to antibiotic exposure. The Proteobacteria phylum dominates, although with marked interindividual variability. The outbreak group considerably differed from the control group, with higher densities of Escherichia coli and Serratia to the detriment of Enterococcus and other Firmicutes. Curiously, obligate predators were only detected in meconium and at very low concentrations. Genotyping of cultivable bacteria demonstrated the high bacterial horizontal transmission rate that was confirmed with whole-genome sequencing for S. marcescens. Preterm infants admitted at NICU are initially colonized by homogeneous microbial communities, most of them from the nosocomial environment, which subsequently evolve according to the individual conditions. Our results demonstrate the hospital epidemiology pressure, particularly during outbreak situations, on the gut microbiota establishing process.
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Affiliation(s)
- Esperanza Escribano
- Servicio de Neonatología, Hospital Universitario La Paz, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudia Saralegui
- Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, and Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain
| | - Laura Moles
- Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, and Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain.,Departamento de Bromatología, Facultad de Veterinaria Nutrición y Ciencia de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
| | - María Teresa Montes
- Servicio de Neonatología, Hospital Universitario La Paz, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Claudio Alba
- Servicio de Microbiología, Hospital Universitario La Princesa, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Alarcón
- Servicio de Microbiología, Hospital Universitario La Princesa, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Juan Miguel Rodríguez
- Departamento de Bromatología, Facultad de Veterinaria Nutrición y Ciencia de los Alimentos, Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel Sáenz de Pipaón
- Servicio de Neonatología, Hospital Universitario La Paz, and Universidad Autónoma de Madrid, Madrid, Spain.,Red de Salud Materno Infantil y del Desarrollo, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Del Campo
- Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, and Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain
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Rohit A, Suresh Kumar D, Dhinakaran I, Joy J, Vijay Kumar D, Kumar Ballamoole K, Karunasagar I, Karola P, Dag H. Whole-genome-based analysis reveals multiclone Serratia marcescens outbreaks in a non-Neonatal Intensive Care Unit setting in a tertiary care hospital in India. J Med Microbiol 2019; 68:616-621. [PMID: 30839251 DOI: 10.1099/jmm.0.000947] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We report the use of next generation sequencing (NGS) for investigating an outbreak of 13 cases of Serratia marcescens blood stream infections in a non-Neonatal Intensive Care Unit (non-NICU) setting in a tertiary care hospital in India over 5 months. Thirteen cases of sepsis due to S. marcescens were identified in various Intensive Care Units (ICUs) over 5 months. Environmental surveillance identified isolates in the adult ICU (AICU). Antibiogram did not correlate with timeline. Sequencing libraries were prepared using Nextera XT chemistry (Illumina). Based on NGS, two clusters were identified. Cluster 1 had environmental and clinical isolates from the AICU and cluster 2 were isolates from the Coronary Care Unit (CCU). NICU and Paediatric ICU isolates did not belong to any cluster. Polyclonal outbreaks best identified by NGS can occur simultaneously. Good infection prevention practices like hand hygiene for compounded medicines and surface cleaning helped end the outbreak.
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Affiliation(s)
- Anusha Rohit
- Department of Microbiology and Infection Control, The Madras Medical Mission, Mogappair, Chennai 600037, India
| | - D Suresh Kumar
- Department of Microbiology and Infection Control, The Madras Medical Mission, Mogappair, Chennai 600037, India
| | - I Dhinakaran
- Department of Microbiology and Infection Control, The Madras Medical Mission, Mogappair, Chennai 600037, India
| | - Jessy Joy
- Department of Microbiology and Infection Control, The Madras Medical Mission, Mogappair, Chennai 600037, India
| | - Deekshit Vijay Kumar
- Division of Infectious Disease, Centre for Science Education and Research, Nitte (Deemed to be University), Deralakatte, Mangaluru 575018, India
| | - Krishna Kumar Ballamoole
- Division of Infectious Disease, Centre for Science Education and Research, Nitte (Deemed to be University), Deralakatte, Mangaluru 575018, India
| | - I Karunasagar
- Division of Infectious Disease, Centre for Science Education and Research, Nitte (Deemed to be University), Deralakatte, Mangaluru 575018, India
| | - Prior Karola
- Department of Periodontology and Restorative Dentistry, Muenster University Hospital, Waldeyerstrasse 30, 48149 Muenster, Germany
| | - Harmsen Dag
- Department of Periodontology and Restorative Dentistry, Muenster University Hospital, Waldeyerstrasse 30, 48149 Muenster, Germany
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Redondo-Bravo L, Gutiérrez-González E, San Juan-Sanz I, Fernández-Jiménez I, Ruiz-Carrascoso G, Gallego-Lombardo S, Sánchez-García L, Elorza-Fernández D, Pellicer-Martínez A, Omeñaca F, Robustillo-Rodela A. Serratia marcescens outbreak in a neonatology unit of a Spanish tertiary hospital: Risk factors and control measures. Am J Infect Control 2019; 47:271-279. [PMID: 30392995 DOI: 10.1016/j.ajic.2018.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND We describe the investigation undertaken and the measures adopted to control a Serratia marcescens outbreak in the neonatology unit of La Paz University Hospital in Madrid, Spain. METHODS Weekly rectal and pharyngeal screenings for S marcescens were performed in the neonates starting after detection of the outbreak. Environmental samples and samples from health care workers (HCWs) were obtained for microbiological analysis. An unmatched case-control study was carried out to investigate risk factors for infection/colonization. RESULTS The outbreak began in June 2016 and ended in March 2017, affecting a total of 59 neonates. Twenty-five (42.37%) neonates sustained an infection, most frequently conjunctivitis and sepsis. Multivariate logistic regression identified the following risk factors: parenteral nutrition (odds ratio [OR], 103.4; 95% confidence interval [CI], 11.9-894.8), history of previous radiography (OR, 15.3; 95% CI, 2.4-95.6), and prematurity (OR, 5.65; 95% CI, 1.5-21.8). Various measures were adopted to control the outbreak, such as strict contact precautions, daily multidisciplinary team meetings, cohorting, allocation of dedicated staff, unit disinfection, and partial closure. Hands of HCWs were the main suspected mechanism of transmission, based on the inconclusive results of the environmental investigation and the high number of HCWs and procedures performed in the unit. CONCLUSIONS S marcescens spreads easily in neonatology units, mainly in neonatal intensive care units, and is often difficult to control, requiring a multidisciplinary approach. Strict measures, including cohorting and medical attention by exclusive staff, are often needed to get these outbreaks under control.
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Affiliation(s)
- Lidia Redondo-Bravo
- Department of Preventive Medicine, La Paz University Hospital, Madrid, Spain.
| | | | | | | | | | | | | | | | | | - Félix Omeñaca
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
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Serratia marcescens Infections in Neonatal Intensive Care Units (NICUs). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040610. [PMID: 30791509 PMCID: PMC6406414 DOI: 10.3390/ijerph16040610] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 01/21/2023]
Abstract
Serratia marcescens belongs to the family Enterobacteriaceae, which is commonly found in water, soil, animals, insects, plants. Although S. marcescens displays relatively low virulence, it causes nosocomial infections and outbreaks in severely immunocompromised or critically ill patients, particularly in settings such as intensive care units (ICUs), especially neonatal units (NICUs). This microorganism gives rise to a wide range of clinical manifestations in newborns: from asymptomatic colonization to keratitis, conjunctivitis, urinary tract infections, pneumonia, surgical wound infections, sepsis, bloodstream infection and meningitis. The most frequent site of infection is the bloodstream, followed by the respiratory apparatus and the gastrointestinal tract. Strains of S. marcescens involved in epidemic events have frequently proved to be multi-resistant. Indeed, this species displays intrinsic resistance to several classes of antibiotics. Often, the specific source of the infection cannot be identified. However, the contaminated hands of healthcare workers are believed to be a major vehicle of its transmission. In neonatal intensive care units, colonized or infected newborns are the main potential source of S. marcescens, particularly in the respiratory apparatus, but also in the gastrointestinal tract. The early identification of colonized or infected patients and the prompt implementation of infection control measures, particularly rigorous hand hygiene and contact precautions, are essential in order to curb the spread of infection.
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Alrumi N, Aghaalkurdi M, Habib H, Abed S, Böttcher B. Infection control measures in neonatal units: implementation of change in the Gaza-Strip. J Matern Fetal Neonatal Med 2019; 33:3490-3496. [PMID: 30691321 DOI: 10.1080/14767058.2019.1576168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Low-income countries rarely report infection control measures although they are key to reducing mortality and morbidity in healthcare. This audit examined healthcare personnel's adherence to infection control measures before entry to the NICU and in both minor and major procedures' bundles. Furthermore, it examined the effect of subsequent authorization and dissemination of infection control guidelines followed by education and training sessions on the adherence of healthcare personnel to infection control policies.Methods: This prospective observational study was conducted in two NICUs at two separate hospitals in the Gaza-Strip, Palestine. The initial observation period was June-August 2016 during which healthcare professionals' adherence to infection control policies was assessed by direct observation. This was followed by NICU feedback dissemination and on-site educational and training sessions. Then, the reaudit, following the same protocol, was carried out throughout February 2017.Results: There was a statistically significant improvement in the adherence to infection control measures among healthcare personnel. Significant improvements were found in both minor and major procedure infection control protocols' adherence rates. However, when comparing the general neonatal handling adherence rate between both audits, no significant change was noted.Discussion: This study highlights the effectiveness of using audit feedback and on-site educational and training sessions in the enhancement of adherence to infection control policies, demonstrating significant improvement in areas covered by the staff training program. Therefore, including regular infection control training combined with feedback in the curriculum of healthcare professionals can improve the sustainability of infection control programs. Further studies must examine the impact of such training also on the incidence of healthcare-associated infection rates as well as morbidity and mortality within neonatal units.
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Affiliation(s)
- N Alrumi
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestinian Territories
| | - M Aghaalkurdi
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestinian Territories
| | - H Habib
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestinian Territories
| | - S Abed
- Al Nassr Pediatric Hospital, Gaza, Palestinian Territories
| | - B Böttcher
- Evidence Based Medicine Unit, Faculty of Medicine, Islamic University of Gaza, Gaza, Palestinian Territories
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Vásquez Hoyos P, Soto F, Pinzón D, González D, Peña C. Caracterización de pacientes pediatricos con hemocultivos positivos del servicio de cuidado intensivo pediátrico del Hospital San José Bogotá, abril 2012 a 2017. INFECTIO 2019. [DOI: 10.22354/in.v23i2.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introducción: El cultivo de la sangre es el método más utilizado en la búsqueda de infecciones del paciente pediátrico porque orienta la terapia antimicrobiana.Objetivo: Determinar la incidencia de hemocultivos positivos y su caracterización microbiológica en pacientes de cuidado intensivo pediátrico del Hospital de San José, Bogotá-Colombia.Materiales y métodos: Descripción de hemocultivos positivos en pacientes pediátricos de la unidad desde abril de 2012 a 2017. Se determinó la incidencia de hemocultivos positivos y se describió la población estudiada y los gérmenes aislados incluido su perfil de antibiograma.Resultados: Ingresaron 1773 pacientes a la UCIP, 241 pacientes (13,6%) fueron hemocultivados, de los cuales 80 (33,2%) fueron positivos, pero 50% de estos fueron catalogados como contaminaciones. La mediana de edad fue de 21 meses, con 64% de sexo masculino. El 57% fue ventilado y 45% tuvieron un catéter central. La mortalidad fue de 15,4%. La patología más frecuentemente fue respiratoria (75%). De los gérmenes no contaminantes el más frecuente aislado fue Staphylococcus aureus (30%), seguido de Klebsiella pneumoniae (17,5%) y Streptococcus pneumoniae (17,5%). El germen contaminante más frecuente fue Staphylococcus epidermidis (47,5%).Conclusión: La frecuencia de hemocultivos positivos es baja y es frecuente que se aíslen gérmenes contaminantes. El patrón fue similar a lo reportado por la red GREBO.
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Vieira CB, Praça YR, Bentes KLDS, Santiago PB, Silva SMM, Silva GDS, Motta FN, Bastos IMD, de Santana JM, de Araújo CN. Triatomines: Trypanosomatids, Bacteria, and Viruses Potential Vectors? Front Cell Infect Microbiol 2018; 8:405. [PMID: 30505806 PMCID: PMC6250844 DOI: 10.3389/fcimb.2018.00405] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022] Open
Abstract
Triatominae bugs are the vectors of Chagas disease, a major concern to public health especially in Latin America, where vector-borne Chagas disease has undergone resurgence due mainly to diminished triatomine control in many endemic municipalities. Although the majority of Triatominae species occurs in the Americas, species belonging to the genus Linshcosteus occur in India, and species belonging to the Triatoma rubrofasciata complex have been also identified in Africa, the Middle East, South-East Asia, and in the Western Pacific. Not all of Triatominae species have been found to be infected with Trypanosoma cruzi, but the possibility of establishing vector transmission to areas where Chagas disease was previously non-endemic has increased with global population mobility. Additionally, the worldwide distribution of triatomines is concerning, as they are able to enter in contact and harbor other pathogens, leading us to wonder if they would have competence and capacity to transmit them to humans during the bite or after successful blood feeding, spreading other infectious diseases. In this review, we searched the literature for infectious agents transmitted to humans by Triatominae. There are reports suggesting that triatomines may be competent vectors for pathogens such as Serratia marcescens, Bartonella, and Mycobacterium leprae, and that triatomine infection with other microrganisms may interfere with triatomine-T. cruzi interactions, altering their competence and possibly their capacity to transmit Chagas disease.
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Affiliation(s)
- Caroline Barreto Vieira
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Yanna Reis Praça
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Kaio Luís da Silva Bentes
- Laboratório de Interação Patógeno-Hospedeiro, Instituto de Ciências Biológicas, Departamento de Biologia Celular, Universidade de Brasília, Brasília, Brazil
| | - Paula Beatriz Santiago
- Laboratório de Interação Patógeno-Hospedeiro, Instituto de Ciências Biológicas, Departamento de Biologia Celular, Universidade de Brasília, Brasília, Brazil
| | - Sofia Marcelino Martins Silva
- Laboratório de Interação Patógeno-Hospedeiro, Instituto de Ciências Biológicas, Departamento de Biologia Celular, Universidade de Brasília, Brasília, Brazil
| | - Gabriel dos Santos Silva
- Laboratório de Interação Patógeno-Hospedeiro, Instituto de Ciências Biológicas, Departamento de Biologia Celular, Universidade de Brasília, Brasília, Brazil
| | - Flávia Nader Motta
- Laboratório de Interação Patógeno-Hospedeiro, Instituto de Ciências Biológicas, Departamento de Biologia Celular, Universidade de Brasília, Brasília, Brazil
- Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
| | - Izabela Marques Dourado Bastos
- Laboratório de Interação Patógeno-Hospedeiro, Instituto de Ciências Biológicas, Departamento de Biologia Celular, Universidade de Brasília, Brasília, Brazil
| | - Jaime Martins de Santana
- Laboratório de Interação Patógeno-Hospedeiro, Instituto de Ciências Biológicas, Departamento de Biologia Celular, Universidade de Brasília, Brasília, Brazil
| | - Carla Nunes de Araújo
- Laboratório de Interação Patógeno-Hospedeiro, Instituto de Ciências Biológicas, Departamento de Biologia Celular, Universidade de Brasília, Brasília, Brazil
- Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
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Ghaith DM, Zafer MM, Ismail DK, Al-Agamy MH, Bohol MFF, Al-Qahtani A, Al-Ahdal MN, Elnagdy SM, Mostafa IY. First reported nosocomial outbreak of Serratia marcescens harboring bla IMP-4 and bla VIM-2 in a neonatal intensive care unit in Cairo, Egypt. Infect Drug Resist 2018; 11:2211-2217. [PMID: 30519059 PMCID: PMC6233950 DOI: 10.2147/idr.s174869] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction Serratia marcescens is a significant hospital-acquired pathogen, and many outbreaks of S. marcescens infection have been reported in neonates. We report a sudden breakout of S. marcescens harboring the blaIMP-4 and blaVIM-2 metallo-β-lactamase (MBL) genes that occurred from March to August 2015 in the neonatal intensive care unit of Cairo University Hospital, Cairo, Egypt. Methods During the study period, 40 nonduplicate clinical isolates of S. marcescens were collected from blood culture samples. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was used to identify each isolate. Then, minimum inhibitory concentrations of different antibiotics were assessed by the Vitek 2 compact system. Screening of the MBL genes blaIMP, blaVIM, blaSIM-1, blaSPM-1, and blaGIM-1 as well as the carbapenemase genes KPC, NDM, OXA-48, SME-1, and SME-2 were evaluated. Pulsed field gel electrophoresis was preformed to detect the genetic relationship of the isolates. Results Analysis showed that 37.5% of the S. marcescens clinical isolates were resistant to meropenem (minimum inhibitory concentrations ≥ 2 µg/mL), and blaIMP-4 and blaVIM-2 were the most prevalent MBL genes (42.5% and 37.5%, respectively). None of the other investigated genes were observed. Pulsed field gel electrophoresis typing revealed two discrete clones; 33/40 (82.5%) were pulsotype A and 7/40 (17.5%) were pulsotype B. Conclusion Here, we report for the first time the detection of MBL-producing S. marcescens isolates, particularly IMP-4 and VIM-2 recovered from inpatients with bacteremias from the intensive care unit at Cairo University Hospital.
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Affiliation(s)
- Doaa Mohammad Ghaith
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mai Mahmoud Zafer
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt,
| | - Dalia Kadry Ismail
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hamed Al-Agamy
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Marie Fe F Bohol
- Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Al-Qahtani
- Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed N Al-Ahdal
- Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Sherif M Elnagdy
- Department of Botany and Microbiology, Faculty of Science, Cairo University, Cairo, Egypt
| | - Islam Yousif Mostafa
- Department of Microbiology, Faculty of Dentistry and Oral Medicine, Future University, Cairo, Egypt
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Ranjan M, Karade S, Sen S, Srinivas V. Pseudohemoptysis in an elderly due to Serratia marcescens pneumonitis. Med J Armed Forces India 2018; 74:383-385. [PMID: 30449928 PMCID: PMC6224691 DOI: 10.1016/j.mjafi.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 08/13/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
- Manish Ranjan
- Resident, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - Santosh Karade
- Classified Specialist (Microbiology), Trained in Virology & Retrovirology, Command Hospital (Southern Command), Pune 411040, India
| | - Sourav Sen
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - V. Srinivas
- Consultant and Head, Department of Pathology, Command Hospital (Southern Command), Pune 411040, India
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Serratia marcescens Outbreak in a Neonatal Intensive Care Unit: New Insights from Next-Generation Sequencing Applications. J Clin Microbiol 2018; 56:JCM.00235-18. [PMID: 29899005 DOI: 10.1128/jcm.00235-18] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/12/2018] [Indexed: 12/14/2022] Open
Abstract
Serratia marcescens is an environmental bacterium that is commonly associated with outbreaks in neonatal intensive care units (NICUs). Investigations of S. marcescens outbreaks require efficient recovery and typing of clinical and environmental isolates. In this study, we investigated how the use of next-generation sequencing applications, such as bacterial whole-genome sequencing (WGS) and bacterial community profiling, could improve S. marcescens outbreak investigations. Phylogenomic links and potential antibiotic resistance genes and plasmids in S. marcescens isolates were investigated using WGS, while bacterial communities and relative abundances of Serratia in environmental samples were assessed using sequencing of bacterial phylogenetic marker genes (16S rRNA and gyrB genes). Typing results obtained using WGS for the 10 S. marcescens isolates recovered during a NICU outbreak investigation were highly consistent with those obtained using pulsed-field gel electrophoresis (PFGE), the current standard typing method for this bacterium. WGS also allowed the identification of genes associated with antibiotic resistance in all isolates, while no plasmids were detected. Sequencing of the 16S rRNA and gyrB genes both showed greater relative abundances of Serratia at environmental sampling sites that were in close contact with infected babies. Much lower relative abundances of Serratia were observed following disinfection of a room, indicating that the protocol used was efficient. Variations in the bacterial community composition and structure following room disinfection and among sampling sites were also identified through 16S rRNA gene sequencing. Together, results from this study highlight the potential for next-generation sequencing tools to improve and to facilitate outbreak investigations.
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Åttman E, Korhonen P, Tammela O, Vuento R, Aittoniemi J, Syrjänen J, Mattila E, Österblad M, Huttunen R. A Serratia marcescens outbreak in a neonatal intensive care unit was successfully managed by rapid hospital hygiene interventions and screening. Acta Paediatr 2018; 107:425-429. [PMID: 29068091 DOI: 10.1111/apa.14132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/14/2017] [Accepted: 10/19/2017] [Indexed: 12/17/2022]
Abstract
AIM Serratia marcescens is a rare, but important, pathogen in hospital-acquired infections, especially in neonatal units. Outbreaks may cause significant mortality among neonates. This study describes how an outbreak of S. marcescens was handled in a neonatal intensive care unit in Finland in June 2015. METHODS Tampere University Hospital is the only hospital that offers intensive care for preterm neonates in the Pirkanmaa health district area in Finland. Between June 9, 2015 and June 29, 2015, seven neonates were screened positive for S. marcescens in the hospital. We examined the management and outcomes, including environmental sampling. RESULTS Two of the seven neonates developed a bloodstream infection, and one with S. marcescens sepsis died after six days of antibiotic treatment. The outbreak was rapidly managed with active hospital hygiene interventions, including strict hand hygiene, cleaning, patient screening, contact precautions and education. Environmental sampling was limited to one water tap and a ventilator, and the results were negative. The outbreak was contained within three weeks, and no further cases appeared. The screening of healthcare workers was not necessary. CONCLUSION A S. marcescens outbreak caused significant morbidity in neonates and one death. Rapid hospital hygiene interventions and patient screening effectively contained the outbreak.
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Affiliation(s)
- Emilia Åttman
- Tampere Medical School; University of Tampere; Tampere Finland
| | - Päivi Korhonen
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | - Outi Tammela
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | | | | | - Jaana Syrjänen
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
| | - Erja Mattila
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
| | - Monica Österblad
- Bacterial Infections Unit; National Institute for Health and Welfare; Turku Finland
| | - Reetta Huttunen
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
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Abstract
PURPOSE OF REVIEW Neonates in the neonatal ICU (NICU) are uniquely vulnerable to colonization and infection with pathogens such as multidrug resistant Gram-negative bacteria, which in turn are associated with increased infection-related morbidities and higher case-fatality rates. We reviewed the English, French, and German language literature published between 2015 and 2017, for reports of NICU outbreaks. RECENT FINDINGS A total of 39 outbreaks in NICUs were reported with Gram-negative bacteria (n = 21; 54%) causing most, and extended spectrum beta-lactamase-producing organisms being the most frequent resistance mechanism reported (n = 5). Five viral outbreaks were reported (respiratory syncytial virus = 3). A significant proportion of outbreaks (33%) did not identify a source. Whole genome sequencing was used more (n = 6 reports). The most common described infection prevention and control interventions included staff and parent education on hand hygiene, patient isolation, additional contact precautions, including discontinuation of 'kangaroo care', and cohorting. Reporting and publication bias are likely common. SUMMARY NICUs must be vigilant in identifying outbreaks, conduct comprehensive investigations, and implement targeted infection prevention and control strategies. Molecular epidemiology capacities are an essential element in outbreak investigation. More studies are needed to determine the added value of active colonization screening and their impact on outbreak development.
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An Outbreak of Serratia marcescens in a Moroccan Neonatal Intensive Care Unit. Adv Med 2018; 2018:4867134. [PMID: 30515424 PMCID: PMC6237015 DOI: 10.1155/2018/4867134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/30/2018] [Accepted: 09/13/2018] [Indexed: 11/18/2022] Open
Abstract
Serratia marcescens (S. marcescens) is an Enterobacteriaceae microorganism that is widespread in the environment, which may be the source of nosocomial infections, rare in the newborn but severe, and often in the form of outbreaks. The aim of our study is to report our experience, during an outbreak of S. marcescens, to show the severity of this germ, with review of the literature. Our study was retrospective, including 8 newborns with S. marcescens nosocomial infection, collected in the neonatal intensive care unit of Mohammed VI University Medical Hospital, during the epidemic period, over a period of 2 months (July and August 2016). The mean gestational age of the cases was 36 weeks of amenorrhea. Boys accounted for 75% of the cases. The average weight was 1853 grams. All the patients were initially placed under empiric antibiotic therapy based on ceftriaxone and gentamicin. The mean duration of nosocomial infection, diagnosed in all cases by blood cultures, was 7 days. The strains of S. marcescens were in 75% of the cases sensitive to the cephalosporins, intermediate sensitivity in 12.5% of cases and resistant in 12.5% of cases. The outcome was fatal in 62.5% of cases. S. marcescens nosocomial infections are often reported on epidemic series, and their eradication is not always easy.
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Dynamic profile of the microbiota during coconut water pre-fermentation for nata de coco production. Lebensm Wiss Technol 2017. [DOI: 10.1016/j.lwt.2017.03.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Mahmoudi S, Mahzari M, Banar M, Pourakbari B, Haghi Ashtiani MT, Mohammadi M, Keshavarz Valian S, Mamishi S. Antimicrobial resistance patterns of Gram-negative bacteria isolated from bloodstream infections in an Iranian referral paediatric hospital: A 5.5-year study. J Glob Antimicrob Resist 2017; 11:17-22. [PMID: 28729206 DOI: 10.1016/j.jgar.2017.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/15/2017] [Accepted: 04/19/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Bloodstream infections (BSIs) are a major cause of paediatric morbidity and mortality worldwide. This study describes the epidemiology and antimicrobial resistance of Gram-negative bacteria (GNB) from BSIs in children admitted to an Iranian paediatric hospital. METHODS Clinical and microbiological data of patients with positive blood cultures were collected from March 2011 to September 2016. Standard laboratory methods were used for blood culture and bacterial identification. Antimicrobial sensitivity was evaluated by the Kirby-Bauer disk diffusion and broth microdilution methods. RESULTS Of 2325 bacterial pathogens isolated from blood cultures, 41.1% (n=956) were GNB. Most clinical isolates (n=208; 21.8%) were identified in the cardiac intensive care unit. Predominant bacterial isolates were Klebsiella pneumoniae subsp. pneumoniae (n=263; 27.5%), Escherichia coli (n=192; 20.1%), Serratia marcescens (n=151; 15.8%), Pseudomonas aeruginosa (n=111; 11.6%) and Enterobacter spp. (n=100; 10.5%). Enterobacter isolates showed a high level of ampicillin resistance. Escherichia coli were highly resistant to chloramphenicol (100%), cefixime (100%), ceftriaxone (100%) and ampicillin (96%). Cefixime had the least efficacy against Haemophilus spp. (100% resistant). All K. pneumoniae (100%) were ampicillin-resistant. All S. marcescens were ceftazidime-resistant. No Acinetobacter baumannii were resistant to colistin. All P. aeruginosa were resistant to cefotaxime and trimethoprim/sulfamethoxazole. CONCLUSIONS These results demonstrate the increasing trend in antibiotic resistance among GNB associated with BSI in children, emphasising the importance of continuous screening and surveillance programmes for detection of antibiotic resistance in BSI pathogens for selection of appropriate treatment regimens.
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Affiliation(s)
- Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Mahzari
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Banar
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Mohammadi
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Klebsiella pneumoniae carbapenemase-producing Serratia marcescens outbreak in a university hospital. Am J Infect Control 2017; 45:700-702. [PMID: 28431850 DOI: 10.1016/j.ajic.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
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Maran NH, Crispim BDA, Iahnn SR, Araújo RPD, Grisolia AB, Oliveira KMPD. Depth and Well Type Related to Groundwater Microbiological Contamination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13101036. [PMID: 27775681 PMCID: PMC5086775 DOI: 10.3390/ijerph13101036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 12/16/2022]
Abstract
Use of groundwater from private wells in households has increased considerably, owing to a better cost/benefit ratio than that of water provided by local utilities for a fee. However, this water is usually untreated, which makes it a vehicle for diseases. Thus, monitoring this water is necessary to ensure its integrity and quality. We aimed to evaluate the physical, chemical, and microbiological parameters of untreated groundwater drawn from different types of wells, and the antimicrobial susceptibility profile of the bacteria isolated from this water. Wellwater samples were collected in two Brazilian cities. Although physical and chemical parameters of the water were suitable for drinking, Escherichia coli was detected in 33% of the samples. E. coli contaminated 65% of dug wells and 10.25% of drilled wells. Many bacteria isolated were resistant to multiple antibacterial agents, including β-lactams. Microbial contamination of this water was related to the well depth, and was more common in dug wells, making this water unfit for human consumption. Consumption of such contaminated and untreated water is a public health concern. Thus, individuals who regularly use such water must be alerted so they may either take preventive measures or connect to the water distribution system operated by local utilities.
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Affiliation(s)
- Nayara Halimy Maran
- Faculty of Exact Sciences and Technology, Federal University of Grande Dourados, Dourados, MS 79804-970, Brazil.
| | - Bruno do Amaral Crispim
- Faculty of Exact Sciences and Technology, Federal University of Grande Dourados, Dourados, MS 79804-970, Brazil.
| | - Stephanie Ramirez Iahnn
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, MS 79804-970, Brazil.
| | - Renata Pires de Araújo
- Faculty of Biological and Environmental Science, Federal University of Grande Dourados, Dourados, MS 79804-970, Brazil.
| | - Alexeia Barufatti Grisolia
- Faculty of Exact Sciences and Technology, Federal University of Grande Dourados, Dourados, MS 79804-970, Brazil.
- Faculty of Biological and Environmental Science, Federal University of Grande Dourados, Dourados, MS 79804-970, Brazil.
| | - Kelly Mari Pires de Oliveira
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, MS 79804-970, Brazil.
- Faculty of Biological and Environmental Science, Federal University of Grande Dourados, Dourados, MS 79804-970, Brazil.
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Dawczynski K, Proquitté H, Roedel J, Edel B, Pfeifer Y, Hoyer H, Dobermann H, Hagel S, Pletz MW. Intensified colonisation screening according to the recommendations of the German Commission for Hospital Hygiene and Infectious Diseases Prevention (KRINKO): identification and containment of a Serratia marcescens outbreak in the neonatal intensive care unit, Jena, Germany, 2013-2014. Infection 2016; 44:739-746. [PMID: 27401691 DOI: 10.1007/s15010-016-0922-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE In 2013, the German Commission for Hospital Hygiene and Infectious Disease Prevention (KRINKO) stated that extending weekly colonisation screening from very low birth weight (VLBW) infants (<1500 g) to all patients in the Neonatal Intensive Care Unit (NICU) might be useful. METHODS After implementing this recommendation, we detected a previously unnoticed cluster of Serratia marcescens. Strains were typed by Pulsed Field Gel Electrophoresis (PFGE). RESULTS Over 6 months, 19 out of 159 infants acquired S. marcescens. Twelve of the nineteen patients with S. marcescens were non-VLBW infants, and they were colonised significantly earlier than were VLBW infants (median 17 vs. 28 days; p < 0.01). Molecular typing revealed a polyclonal outbreak with multiple strain types leading to one or two transmissions each and a dominating outbreak strains being involved in an explosive outbreak involving eight neonates. CONCLUSION The revised KRINKO recommendation may help identify unnoticed outbreaks. Colonised non-VLBW patients may be an underestimated source of S. marcescens.
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Affiliation(s)
- Kristin Dawczynski
- Unit Neonatology, Department of Paediatrics, Jena University Hospital, Jena, Germany
| | - Hans Proquitté
- Unit Neonatology, Department of Paediatrics, Jena University Hospital, Jena, Germany
| | - Jürgen Roedel
- Institute for Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Brigit Edel
- Institute for Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Yvonne Pfeifer
- Nosocomial Pathogens and Antibiotic Resistance, Robert Koch Institute, Wernigerode, Germany
| | - Heike Hoyer
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - Helke Dobermann
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Germany
| | - Stefan Hagel
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Germany.
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