RESUMO
OBJECTIVES: To describe the in vivo emergence of ceftazidime-avibactam resistance in GES-type carbapenemases and to characterize an unusual outbreak of GES-6-producing Serratia marcescens during the COVID-19 pandemic in Spain. METHODS: Retrospective study to describe a GES-CPSM outbreak based on whole genome sequencing and antimicrobial susceptibility testing (AST). Transferability of blaGES-carrying plasmid was assessed by conjugation experiments. RESULTS: In December 2020, we identified a cluster of S. marcescens harbouring blaGES-6 involving 9 patients. Whole-genome sequence analysis revealed a clonal relationship (≤3 SNPs) between the first isolates identified in each of the evolved patients and environmental samples with GES-CPSM detection. Plasmid analysis showed that the blaGES-6 gene was located in an IncQ3-type plasmid. Triparental mating experiments using a helper plasmid demonstrated mobilization of the blaGES-6-carrying plasmid. Our results also demonstrate within-host evolution in S. marcescens isolates, leading to a transition from blaGES-6 to the new blaGES-55, caused by the P162S mutation, in a subsequent infection in one of the affected patients. In blaGES-55 we identified emergence of ceftazidime-avibactam resistance along with an increase of carbapenems susceptibility. This patient had been treated with a 14-day course of ceftazidime-avibactam. AST of the transformants bearing blaGES-6 and blaGES-55 plasmids, confirmed susceptibility variation affecting ceftazidime-avibactam and carbapenems. CONCLUSIONS: We report an unusual outbreak of GES-6 whose incidence is becoming increasing. Transition from GES-6 to GES-55 may readily occur in vivo leading to ceftazidime-avibactam resistance, which brings to the fore the critical need for developing more accurate diagnosis tools for detection of GES ß-lactamases and optimise the use of antimicrobials.
Assuntos
Antibacterianos , Compostos Azabicíclicos , Carbapenêmicos , Ceftazidima , Surtos de Doenças , Combinação de Medicamentos , Testes de Sensibilidade Microbiana , Infecções por Serratia , Serratia marcescens , beta-Lactamases , Humanos , Ceftazidima/farmacologia , Serratia marcescens/genética , Serratia marcescens/efeitos dos fármacos , Serratia marcescens/isolamento & purificação , Compostos Azabicíclicos/farmacologia , Infecções por Serratia/microbiologia , Infecções por Serratia/epidemiologia , beta-Lactamases/genética , beta-Lactamases/metabolismo , Estudos Retrospectivos , Carbapenêmicos/farmacologia , Masculino , Antibacterianos/farmacologia , Feminino , Pessoa de Meia-Idade , Plasmídeos/genética , Espanha/epidemiologia , COVID-19/epidemiologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Sequenciamento Completo do Genoma , Idoso , Farmacorresistência Bacteriana Múltipla/genéticaRESUMO
In 2022, an outbreak with severe bloodstream infections caused by Serratia marcescens occurred in an adult intensive care unit (ICU) in Hungary. Eight cases, five of whom died, were detected. Initial control measures could not stop the outbreak. We conducted a matched case-control study. In univariable analysis, the cases were more likely to be located around one sink in the ICU and had more medical procedures and medications than the controls, however, the multivariable analysis was not conclusive. Isolates from blood cultures of the cases and the ICU environment were closely related by whole genome sequencing and resistant or tolerant against the quaternary ammonium compound surface disinfectant used in the ICU. Thus, S. marcescens was able to survive in the environment despite regular cleaning and disinfection. The hospital replaced the disinfectant with another one, tightened the cleaning protocol and strengthened hand hygiene compliance among the healthcare workers. Together, these control measures have proved effective to prevent new cases. Our results highlight the importance of multidisciplinary outbreak investigations, including environmental sampling, molecular typing and testing for disinfectant resistance.
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Infecção Hospitalar , Surtos de Doenças , Desinfetantes , Unidades de Terapia Intensiva , Infecções por Serratia , Serratia marcescens , Humanos , Serratia marcescens/efeitos dos fármacos , Serratia marcescens/genética , Serratia marcescens/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Hungria/epidemiologia , Infecções por Serratia/epidemiologia , Infecções por Serratia/microbiologia , Desinfetantes/farmacologia , Estudos de Casos e Controles , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Sequenciamento Completo do Genoma , Desinfecção/métodos , Idoso , Controle de Infecções/métodos , Farmacorresistência BacterianaRESUMO
INTRODUCTION: Serratia marcescens is an opportunistic pathogen found ubiquitously in the environment and associated with a wide range of nosocomial infections. This multidrug-resistant bacterium has been a cause of concern for hospitals and healthcare facilities due to its ability to spread rapidly and cause outbreaks. Next generation sequencing genotyping of bacterial isolates has proven to be a valuable tool for tracking the spread and transmission of nosocomial infections. This has allowed for the identification of outbreaks and transmission chains, as well as determining whether cases are due to endogenous or exogenous sources. Evidence of nosocomial transmission has been gathered through genotyping methods. The aim of this study was to investigate the genetic diversity of carbapenemase-producing S. marcescens in an outbreak at a public hospital in Cuiaba, MT, Brazil. METHODOLOGY: Ten isolates of S. marcenses were sequenced and antibiotic resistance profiles analyzed over 12 days. RESULTS: The isolates were clonal and multidrug resistant. Gentamycin and tigecycline had sensitivity in 90% and 80% isolates, respectively. Genomic analysis identified several genes that encode ß-lactamases, aminoglycoside-modifying enzymes, efflux pumps, and other virulence factors. CONCLUSIONS: Systematic surveillance is crucial in monitoring the evolution of S. marcescens genotypes, as it can lead to early detection and prevention of outbreaks.
Assuntos
Antibacterianos , Infecção Hospitalar , Surtos de Doenças , Farmacorresistência Bacteriana Múltipla , Unidades de Terapia Intensiva , Infecções por Serratia , Serratia marcescens , Sequenciamento Completo do Genoma , Serratia marcescens/genética , Serratia marcescens/efeitos dos fármacos , Serratia marcescens/isolamento & purificação , Humanos , Brasil/epidemiologia , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Serratia/microbiologia , Infecções por Serratia/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/epidemiologia , Antibacterianos/farmacologia , Testes de Sensibilidade Microbiana , Genótipo , Genoma Bacteriano , beta-Lactamases/genética , Variação GenéticaRESUMO
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.
Assuntos
Infecção Hospitalar , Surtos de Doenças , Controle de Infecções , Infecções por Serratia , Serratia marcescens , Humanos , Surtos de Doenças/prevenção & controle , Serratia marcescens/isolamento & purificação , Serratia marcescens/genética , Singapura/epidemiologia , Controle de Infecções/métodos , Recém-Nascido , Infecções por Serratia/epidemiologia , Infecções por Serratia/prevenção & controle , Infecções por Serratia/microbiologia , Fatores de Risco , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/microbiologia , Estudos Retrospectivos , Estudos de Casos e Controles , Feminino , Masculino , Unidades de Terapia Intensiva Neonatal , NeonatologiaRESUMO
BACKGROUND: Serratia marcescens is known to cause outbreaks in neonatal intensive care units (NICUs). Traditionally epidemiological data, antimicrobial resistance patterns and epidemiological typing have been used to guide infection prevention methods. Whole-genome sequencing (WGS) applications such as core-genome multi-locus sequence typing (cgMLST) applied during an outbreak would potentially yield more information. AIM: To use cgMLST to acquire detailed information on the source and spread of bacteria, enabling more efficient control measures during an S. marcescens outbreak at a NICU. METHODS: Neonates admitted to the NICU of the Leiden University Medical Center (LUMC) during an outbreak between September 2023 and January 2024, with S. marcescens being cultured, were included. Environmental samples were taken to search for a common source, antibiotic susceptibility testing was performed, and antimicrobial resistance genes were analysed. FINDINGS: S. marcescens strains from 17 of the 20 positive patients were available for molecular typing. The cgMLST scheme revealed five different complex types consisting of four separate clusters. Multiple clusters made an unidentified persistent environmental source as cause of the outbreak less likely, leading to a quick downscaling of infection prevention measures. Differences were shown in aminoglycoside resistance patterns of isolates within the same complex types and patients. CONCLUSION: The use of ad-hoc cgMLST provided timely data for rational decision-making during an S. marcescens outbreak at the NICU. Antibiotic phenotyping alone was found not to be suitable for studying clonal spread during this outbreak with S. marcescens.
Assuntos
Infecção Hospitalar , Surtos de Doenças , Controle de Infecções , Unidades de Terapia Intensiva Neonatal , Infecções por Serratia , Serratia marcescens , Humanos , Serratia marcescens/genética , Serratia marcescens/efeitos dos fármacos , Serratia marcescens/classificação , Serratia marcescens/isolamento & purificação , Infecções por Serratia/epidemiologia , Infecções por Serratia/microbiologia , Recém-Nascido , Controle de Infecções/métodos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Tipagem Molecular , Países Baixos/epidemiologia , Testes de Sensibilidade Microbiana , Masculino , Tipagem de Sequências Multilocus , Feminino , Sequenciamento Completo do Genoma , Epidemiologia MolecularRESUMO
Serratia marcescens is an environmental gram-negative bacterium that causes invasive disease in rare cases. During 2020-2022, an outbreak of 21 invasive Serratia infections occurred in a prison in California, USA. Most (95%) patients had a history of recent injection drug use (IDU). We performed whole-genome sequencing and found isolates from 8 patients and 2 pieces of IDU equipment were closely related. We also identified social interactions among patients. We recovered S. marcescens from multiple environmental samples throughout the prison, including personal containers storing Cell Block 64 (CB64), a quaternary ammonium disinfectant solution. CB64 preparation and storage conditions were suboptimal for S. marcescens disinfection. The outbreak was likely caused by contaminated CB64 and propagated by shared IDU equipment and social connections. Ensuring appropriate preparation, storage, and availability of disinfectants and enacting interventions to counteract disease spread through IDU can reduce risks for invasive Serratia infections in California prisons.
Assuntos
Infecção Hospitalar , Desinfetantes , Prisioneiros , Infecções por Serratia , Humanos , Serratia marcescens/genética , Infecções por Serratia/epidemiologia , Prisões , Infecção Hospitalar/microbiologia , Surtos de Doenças , California/epidemiologiaRESUMO
BACKGROUND/AIM: Given the characteristics of Serratia marcescens (S. marcescens), this study aimed at investigating its presence in the hands and contact lens cases of orthokeratology wearers, along with the status of bacterial contamination. PATIENTS AND METHODS: The 39 patients received the questionnaires about the background of orthokeratology and hygiene habits. A total of 39 contact lens cases and 39 hand samples from the patients were collected at Show Chwan Memorial Hospital from June to August in 2020 and sent to National Chung Cheng University for DNA extraction and PCR identification. RESULTS: The results indicated a detection rate of 5.13% for S. marcescens in the contact lens cases and 12.82% in the hand samples. Additionally, 66.67% of contact lens case samples and 30.77% of hand samples found positive for 16s bacterial amplicons. The relationship between hand contamination and the duration of contact lens usage were revealed for both S. marcescens (p=0.021) and 16s bacterial amplicons (p=0.048). CONCLUSION: The results indicated that hand hygiene is more critical than focusing on contact lens hygiene when it comes to preventing S. marcescens infections. Nevertheless, both proper hand and contact lens hygiene practices can reduce the detection of bacterial eye pathogens, especially a common intestinal bacterium.
Assuntos
Infecções por Serratia , Serratia marcescens , Humanos , Serratia marcescens/isolamento & purificação , Serratia marcescens/genética , Masculino , Feminino , Infecções por Serratia/microbiologia , Infecções por Serratia/epidemiologia , Infecções por Serratia/diagnóstico , Procedimentos Ortoceratológicos/métodos , Lentes de Contato/microbiologia , Lentes de Contato/efeitos adversos , Criança , Adolescente , Higiene , Higiene das Mãos , Adulto , Mãos/microbiologiaRESUMO
Serratia marcescens is an opportunistic pathogen historically associated with sudden outbreaks in intensive care units (ICUs) and the spread of carbapenem-resistant genes. However, the ecology of S. marcescens populations in the hospital ecosystem remains largely unknown. We combined epidemiological information of 1,432 Serratia spp. isolates collected from sinks of a large ICU that underwent demographic and operational changes (2019-2021) and 99 non-redundant outbreak/non-outbreak isolates from the same hospital (2003-2019) with 165 genomic data. These genomes were grouped into clades (1-4) and subclades (A and B) associated with distinct species: Serratia nematodiphila (1A), S. marcescens (1B), Serratia bockelmannii (2A), Serratia ureilytica (2B), S. marcescens/Serratia nevei (3), and S. nevei (4A and 4B). They may be classified into an S. marcescens complex (SMC) due to the similarity between/within subclades (average nucleotide identity >95%-98%), with clades 3 and 4 predominating in our study and publicly available databases. Chromosomal AmpC ß-lactamase with unusual basal-like expression and prodigiosin-lacking species contrasted classical features of Serratia. We found persistent and coexisting clones in sinks of subclades 4A (ST92 and ST490) and 4B (ST424), clonally related to outbreak isolates carrying blaVIM-1 or blaOXA-48 on prevalent IncL/pB77-CPsm plasmids from our hospital since 2017. The distribution of SMC populations in ICU sinks and patients reflects how Serratia species acquire, maintain, and enable plasmid evolution in both "source" (permanent, sinks) and "sink" (transient, patients) hospital patches. The results contribute to understanding how water sinks serve as reservoirs of Enterobacterales clones and plasmids that enable the persistence of carbapenemase genes in healthcare settings, potentially leading to outbreaks and/or hospital-acquired infections.IMPORTANCEThe "hospital environment," including sinks and surfaces, is increasingly recognized as a reservoir for bacterial species, clones, and plasmids of high epidemiological concern. Available studies on Serratia epidemiology have focused mainly on outbreaks of multidrug-resistant species, overlooking local longitudinal analyses necessary for understanding the dynamics of opportunistic pathogens and antibiotic-resistant genes within the hospital setting. This long-term genomic comparative analysis of Serratia isolated from the ICU environment with isolates causing nosocomial infections and/or outbreaks within the same hospital revealed the coexistence and persistence of Serratia populations in water reservoirs. Moreover, predominant sink strains may acquire highly conserved and widely distributed plasmids carrying carbapenemase genes, such as the prevalent IncL-pB77-CPsm (pOXA48), persisting in ICU sinks for years. The work highlights the relevance of ICU environmental reservoirs in the endemicity of certain opportunistic pathogens and resistance mechanisms mainly confined to hospitals.
Assuntos
Infecção Hospitalar , Unidades de Terapia Intensiva , Infecções por Serratia , Serratia marcescens , Serratia marcescens/genética , Serratia marcescens/isolamento & purificação , Serratia marcescens/classificação , Infecções por Serratia/epidemiologia , Infecções por Serratia/microbiologia , Humanos , Infecção Hospitalar/microbiologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Genoma Bacteriano , Hospitais , Filogenia , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , beta-Lactamases/genética , Testes de Sensibilidade MicrobianaRESUMO
OBJECTIVES: blaKPC-carrying Enterobacterales have post great challenges to global healthcare systems. In this study, we reported the evolution and spread of blaKPC between Serratia marcescens and Klebsiella pneumoniae. METHODS: Four S. marcescens and one K. pneumoniae strains were isolated from the sputum samples of the patient. Antimicrobial susceptibility tests and whole genome sequencing were performed to investigate the phenotype & genotype of strains. Conjugation assays, cloning experiment and kinetic parameters measuring were performed to explore the spread and antimicrobial resistance mechanisms. RESULTS: The evolution and transmission of blaKPC-2 occurred during the treatment of ceftazidime-avibactam and trimethoprim-sulfamethoxazole. Analysis of the antimicrobial susceptibility and genetic profiles of the clinical strains showed that blaKPC-2 evolved into blaKPC-71 and blaKPC-44, together with resistance to ceftazidime-avibactam and carbapenems susceptibility recovery under antimicrobial pressure. Cloning and expression of blaKPC-44 & blaKPC-71 in E. coli DH5α showed that KPC-44 and KPC-71 resulted in a 64â¼128-fold increase in the MIC value for ceftazidime-avibactam. Meanwhile, the kinetic assays also showed that the enzyme activity of KPC-44 and KPC-71 towards carbapenems was destroyed and couldn't be inhibited by avibactam. Based on the conjugation assay and whole genome sequence analyses, we provided evolutionary insights into the transmission pathway trace of blaKPC-bearing plasmids between S. marcescens and K. pneumoniae. CONCLUSIONS: Mixed-species co-infection is one of the risk factors leading to the spread of plasmids carrying carbapenem-resistant genes, and increased surveillance of multidrug-resistant Enterobacterales is urgently needed.
Assuntos
Antibacterianos , Infecções por Klebsiella , Klebsiella pneumoniae , Testes de Sensibilidade Microbiana , Plasmídeos , Infecções por Serratia , Serratia marcescens , Sequenciamento Completo do Genoma , beta-Lactamases , Serratia marcescens/genética , Serratia marcescens/efeitos dos fármacos , Serratia marcescens/isolamento & purificação , Serratia marcescens/enzimologia , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/efeitos dos fármacos , Humanos , Plasmídeos/genética , beta-Lactamases/genética , Infecções por Serratia/microbiologia , Infecções por Serratia/epidemiologia , Antibacterianos/farmacologia , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/epidemiologia , Ceftazidima/farmacologia , Combinação de Medicamentos , Farmacorresistência Bacteriana Múltipla/genética , Compostos Azabicíclicos/farmacologia , Escarro/microbiologia , Evolução Molecular , Transferência Genética Horizontal , Carbapenêmicos/farmacologiaRESUMO
BACKGROUND: Serratia marcescens is a gram-negative bacterium that is widespread in the environment. S. marcescens bacteremia can be fatal during pregnancy and cause persistent chorioamnionitis. This study reports an outbreak of Serratia marcescens bloodstream infection (BSI) among high-risk pregnant women in an obstetric ward. The purpose of this study is to report our experience with the usefulness of the ATP test in hospital environmental management and to confirm that bloodstream infections of patients with the same strain were correlated by WGS testing. METHODS: This retrospective study collected the data of inpatients with S. marcescens bacteremia in obstetric ward for high-risk pregnant women from August 22, 2021, to October 14, 2021. We performed: an adenosine triphosphate (ATP) bioluminescence test in the environment with a high-contact area; environmental culture; on-site monitoring and staff education; and whole-genome sequencing (WGS) to evaluate genetic relationships among S. marcescens isolates. RESULTS: S. marcescens BSI occurred in four consecutive patients. None of the patients had central venous catheters. An ATP bioluminescence test revealed that high-contact areas and areas for injection preparation were not clean (≥ 1000 relative light units). However, S. marcescens was not identified in the environmental cultures, likely due to intensive environmental cleaning and discarding of potentially contaminated specimens before the culture test. On-site monitoring and education were conducted for 1 month. There were no further reports of BSI until 6 months after the last patient was discharged. WGS performed on three isolates from three patients indicated that the isolated S. marcescens was likely from the same strain. CONCLUSIONS: We controlled an S. marcescens outbreak by improving environmental cleaning as well as education of and behavior changes in healthcare workers. Using the ATP bioluminescence test can provide feedback on environmental cleaning and education. WGS played a role in determining the spread of BSI caused by the same strain.
Assuntos
Bacteriemia , Infecção Hospitalar , Sepse , Infecções por Serratia , Gravidez , Humanos , Feminino , Recém-Nascido , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Gestantes , Serratia marcescens/genética , Estudos Retrospectivos , Infecções por Serratia/epidemiologia , Infecções por Serratia/microbiologia , Sepse/epidemiologia , Surtos de Doenças , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Hospitais , Trifosfato de Adenosina , Unidades de Terapia Intensiva NeonatalRESUMO
OBJECTIVES: To evaluate the clinical and epidemiological impact of a new molecular surveillance strategy based on qPCR to control an outbreak by Serratia marcescens in a Neonatal Intensive Care Unit (NICU). METHODS: We design a specific qPCR for the detection of S. marcescens in rectal swabs of patients admitted to a NICU. We divided the surveillance study into two periods: (a) the pre-PCR, from the outbreak declaration to the qPCR introduction, and (b) the PCR period, from the introduction of the qPCR until the outbreak was solved. In all cases, S. marcescens isolates were recovered and their clonal relationship was analysed by PFGE. Control measures were implemented during the outbreak. Finally, the number of bloodstream infections (BSI) was investigated in order to evaluate the clinical impact of this molecular strategy. RESULTS: Nineteen patients colonized/infected by S. marcescens were detected in the pre-PCR period (October 2020-April 2021). On the contrary, after the PCR implementation, 16 new patients were detected. The PFGE revealed 24 different pulsotypes belonging to 7 different clonal groups, that were not overlapping at the same time. Regarding the clinical impact, 18 months after the qPCR implementation, no more outbreaks by S. marcescens have been declared in the NICU of our hospital, and only 1 episode of BSI has occurred, compared with 11 BSI episodes declared previously to the outbreak control. CONCLUSIONS: The implementation of this qPCR strategy has proved to be a useful tool to control the nosocomial spread of S. marcescens in the NICU.
Assuntos
Infecção Hospitalar , Sepse , Infecções por Serratia , Recém-Nascido , Humanos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/diagnóstico , Unidades de Terapia Intensiva Neonatal , Serratia marcescens/genética , Infecções por Serratia/epidemiologia , Infecções por Serratia/prevenção & controle , Infecções por Serratia/diagnóstico , Reação em Cadeia da Polimerase , Sepse/epidemiologia , Surtos de DoençasRESUMO
BACKGROUND: Nine surgical site infections caused by Serratia marcescens were diagnosed in neurosurgical patients in a 3500-bed hospital between 2nd February and 6th April 2022. OBJECTIVE: To trace the source of infections caused by S. marcescens to expedite termination of the outbreak and prevent future epidemics. METHODS: A review of all surgical procedures and cultures yielding S. marcescens since February 2022 was conducted. Samples were collected from patients and environmental sources. S. marcescens isolates were characterized by antibiotic susceptibility testing. Whole-genome sequencing (WGS) was used to investigate genetic relationships. Resistance genes, virulence genes and plasmid replicons were identified. RESULTS: S. marcescens was isolated from patients' puncture fluid, cerebrospinal fluid and other secretions, and was also cultured from the barbers' haircutting tools, including leather knives, slicker scrapers and razors. In total, 15 isolates were obtained from patients and eight isolates were obtained from haircutting tools. All isolates exhibited identical antibiotic resistance patterns. WGS revealed close clustering among the 23 isolates which differed significantly from previous strains. Three resistance genes and nine virulence-associated genes were detected in all isolates, and 19 of 23 isolates harboured an MOBP-type plasmid. The results confirmed an outbreak of S. marcescens, which was traced to contaminated haircutting tools in the hospital barber shop. The outbreak ended after extensive reinforcement of infection control procedures and re-education of the barbers. CONCLUSIONS: These results highlight the risk of postoperative infections related to pre-operative skin preparation, and demonstrate the value of next-generation sequencing tools to expedite outbreak investigations.
Assuntos
Infecção Hospitalar , Infecções por Serratia , Humanos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/diagnóstico , Surtos de Doenças , Genômica , Hospitais , Infecções por Serratia/epidemiologia , Serratia marcescens/genéticaRESUMO
Carbapenemase-producing-Serratia marcescens isolates, although infrequent, are considered important nosocomial pathogens due to their intrinsic resistance to polymyxins, which limits therapeutic options. We describe a nosocomial outbreak of SME-4-producing S. marcescens in Buenos Aires city which, in our knowledge, represents the first one in South America.
Assuntos
Infecção Hospitalar , Infecções por Serratia , Humanos , Serratia marcescens , beta-Lactamases , Infecções por Serratia/epidemiologia , Infecção Hospitalar/epidemiologia , América do Sul/epidemiologia , Surtos de DoençasRESUMO
Compelling evidence suggests a contribution of the sink environment to the transmission of opportunistic pathogens from the hospital environment to patients in neonatal intensive care units (NICU). In this study, the distribution of the opportunistic pathogen Serratia marcescens in the sink environment and newborns in a NICU was investigated. More than 500 sink drain and faucet samples were collected over the course of five sampling campaigns undertaken over 3 years. Distribution and diversity of S. marcescens were examined with a modified MacConkey medium and a high-throughput short-sequence typing (HiSST) method. Sink drains were an important reservoir of S. marcescens, with an average of 44% positive samples, whereas no faucet sample was positive. The genotypic diversity of S. marcescens was moderate, with an average of two genotypes per drain, while the spatial distribution of S. marcescens was heterogeneous. The genotypic profiles of 52 clinical isolates were highly heterogeneous, with 27 unique genotypes, of which 71% of isolates were found in more than one patient. S. marcescens acquisition during the first outbreaks was mainly caused by horizontal transmissions. HiSST analyses revealed 10 potential cases of patient-to-patient transmission of S. marcescens, five cases of patient-to-sink transmission, and one bidirectional transfer between sink and patient. Environmental and clinical isolates were found in sink drains up to 1 year after the first detection, supporting persisting drain colonization. This extensive survey suggests multiple reservoirs of S. marcescens within the NICU, including patients and sink drains, but other external sources should also be considered. IMPORTANCE The bacterium Serratia marcescens is an important opportunistic human pathogen that thrives in many environments, can become multidrug resistant, and is often involved in nosocomial outbreaks in neonatal intensive care units (NICU). We evaluated the role of sinks during five suspected S. marcescens outbreaks in a NICU. An innovative approach combining molecular and culture methods was used to maximize the detection and typing of S. marcescens in the sink environment. Our results indicate multiple reservoirs of S. marcescens within the NICU, including patients, sink drains, and external sources. These results highlight the importance of sinks as a major reservoir of S. marcescens and potential sources of future outbreaks.
Assuntos
Infecção Hospitalar , Infecções por Serratia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Infecção Hospitalar/microbiologia , Serratia marcescens/genética , Infecções por Serratia/epidemiologia , Surtos de DoençasRESUMO
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.
Assuntos
Doenças do Prematuro , Infecções por Serratia , Lactente , Recém-Nascido , Humanos , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Infecções por Serratia/epidemiologia , Recém-Nascido de muito Baixo Peso , Idade Gestacional , SerratiaRESUMO
BACKGROUND: Serratia marcescens may cause severe nosocomial infections, mostly in very low birth weight infants. Since S. marcescens exhibits by far the highest adjusted incidence rate for horizontal transmission, it can cause complex outbreak situations in neonatal intensive care units. OBJECTIVE: The aim of this study was to establish a fast and highly sensitive colonization screening for prompt cohorting and barrier nursing strategies. METHODS: A probe-based duplex PCR assay targeting the 16S rRNA gene of S. marcescens was developed and validated by using 36 reference strains, 14 S. marcescens outbreak- and nonoutbreak isolates, defined by epidemiological linkage and molecular typing, and applied in 1,347 clinical specimens from 505 patients. RESULTS AND CONCLUSIONS: The novel PCR assay proved to be highly specific and had an in vitro sensitivity of 100 gene copies per reaction (â¼15 bacteria). It showed a similar (in laryngeal/tracheal specimens) or even higher (in rectal/stoma swabs) in vivo sensitivity in comparison to routine microbial culture and was much quicker (<24 h vs. 2 days). By combining different oligonucleotide primers, there was robust detection of genetic variants of S. marcescens strains. PCR inhibition was low (1.6%) and observed with rectal swabs only. Cohort analysis illustrated applicability of the PCR assay as a quick tool to prevent outbreak scenarios by allowing rapid decisions on cohorting and barrier nursing. In summary, this novel molecular screening for colonization by S. marcescens is specific, highly sensitive, and substantially accelerates detection.
Assuntos
Infecção Hospitalar , Infecções por Serratia , Recém-Nascido , Lactente , Humanos , Unidades de Terapia Intensiva Neonatal , Serratia marcescens/genética , RNA Ribossômico 16S , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/microbiologia , Reação em Cadeia da Polimerase , Surtos de Doenças/prevenção & controle , Infecções por Serratia/diagnóstico , Infecções por Serratia/epidemiologia , Infecções por Serratia/prevenção & controleRESUMO
OBJECTIVE: Investigation of the origin of a Serratia marcescens outbreak in a neonatal intensive care unit. DESIGN: Retrospective case-control study. SETTING: Regional level 3 perinatal center in Germany. PATIENTS: This study included 4 S. marcescens-positive and 19 S. marcescens-negative neonates treated between February 1 and February 26, 2019, in the neonatal intensive care unit. METHODS: A case-control study was performed to identify the source of the outbreak. The molecular investigation of S. marcescens isolates collected during the outbreak was performed using pulsed-field gel electrophoresis and next-generation sequencing. RESULTS: The retrospective case-control study showed a significant correlation (P < .0001) between S. marcensens infection or colonization and consumption of donor milk that had tested negative for pathogenic bacteria from a single breast milk donor. Pulsed-field gel electrophoresis and next-generation sequencing retrospectively confirmed an S. marcescens strain isolated from the breast milk of this donor as the possible origin of the initial outbreak. The outbreak was controlled by the implementation of an infection control bundle including a multidisciplinary infection control team, temporary nutrition of infants with formula only and/or their mother's own milk, repeated screening of all inpatients, strict coat and glove care, process observation, retraining of hand hygiene and continuous monitoring of environmental cleaning procedures. CONCLUSIONS: Low-level contaminated raw donor milk can be a source of infection and colonization of preterm infants with S. marcescens even if it tests negative for bacteria.
Assuntos
Infecção Hospitalar , Infecções por Serratia , Lactente , Feminino , Recém-Nascido , Humanos , Unidades de Terapia Intensiva Neonatal , Infecção Hospitalar/prevenção & controle , Recém-Nascido Prematuro , Serratia marcescens/genética , Estudos Retrospectivos , Estudos de Casos e Controles , Infecções por Serratia/epidemiologia , Surtos de Doenças , Leite Humano , Eletroforese em Gel de Campo PulsadoRESUMO
BACKGROUND: Serratia marcescens (Sm) is a known cause of infection and colonization in neonates receiving intensive care. The aim of this study was to identify the risk factors for colonization and infection with Sm in Neonatal Intensive Care Unit (NICU) of a tertiary care Hospital. METHODS: A case-control study was conducted from January to December 2011 in neonates admitted to the NICU. Cases are patients with a microbiologically confirmed infection or colonization, controls were randomly chosen among patients admitted to the same NICU. RESULTS: Globally, 39 acquired infections or colonizations were identified. Among factors related to pregnancy, only premature delivery was independently associated to the risk of infection; as well as mechanical ventilation and catheterization for parenteral nutrition, considering indwelling devices. Prolonged administration with antibiotics were also related to the risk of infection. Among Sm strains which have been tested to antibiotics, all have been resistant to amoxicillin/clavulanic acid and to colistin. CONCLUSIONS: This study confirms the association between Sm infection or colonization and low gestational age. Invasive medical devices and medications, strictly necessary in care-support of preterm neonates, are likely related to Sm infection too. Preventive control strategies are expected to be effective in the control of Sm spread in NICUs.
Assuntos
Infecção Hospitalar , Infecções por Serratia , Recém-Nascido , Gravidez , Feminino , Humanos , Estudos de Casos e Controles , Unidades de Terapia Intensiva Neonatal , Serratia marcescens , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Infecções por Serratia/epidemiologia , Infecções por Serratia/microbiologia , Infecções por Serratia/prevenção & controle , Antibacterianos/uso terapêutico , Itália/epidemiologia , HospitaisRESUMO
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.