Serratia marcescens sepsicemia; Nosocomial outbreak

ABSTRACT

An outbreak of nosocomial infections caused by Serratia marcescens is described. There were 40 bacterial isolates from 21 patients during a 3 month period at pediatric ward and sick baby room. Bacterial cultures from blood revealed positive in 19 patients out of 21, but one from urine and the other from bronchial secretions. 16 cases among 19 Serratia septicemia were completely recovered, but 3 patients were discharged without adequate treatment. We lost two patients in spite of vigorous medical treatment. Factors associated with Serratia infections were previous multiple and ?road-spectrum antimicrobial therapy and underlying chronic debilitating disese. Indwelling intravenous catheter and previously instrumented urinary tract were the most frequent portals of entry. The isolated strains were resisant to most antibiotics, but most frequently sensitvive to gentamicin, amikacin and chloramphenicoI. It is recommended that until specific antibiotic sensitivities can be obtained, patients with Serratia septicemia should be treated with chloramphenciol in combination with gentamicin or amikacin. Dust collection of the sick baby room, the incubators of the pediatric ward and the nurse room were contaminated with serratia marcescens. The distilled water of the cold steam and incubator were also contaminated. The culture of the specimens from the hands of doctors and nurses revealed many Serratia organisms. The control measures were instituted and the outbreak stopped. These data demonstrate that the organism can become pathogenic for man in certain clinical situations, especially in patients with chronic debilitating disease who have been treated with multiple antibiotics. These experience emphasized the problems in recognition of hospital associated infections.