Implicación de un brote nacional de infección por Serratia marcescens asociado a clorhexidina contaminada en un hospital pediátrico / Implication of a national outbreak of Serratia marcescens associated with a contaminated solution of chlorhexidine in a paediatric hospital

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Costs associated with influenza-related hospitalization in the elderly.

Seasonal influenza epidemics remain a considerable burden in adults, especially in those at higher risk of complications. The aim of this study was to determine the costs associated with influenza-related hospitalization in patients aged ≥65 y admitted to 20 hospitals from 7 Spanish regions during the 2013-14 and 2014-15 influenza seasons. Bivariate analysis was used to compare costs in vaccinated and unvaccinated cases. Costs were calculated according to the Spanish National Health System diagnosis-related group tables for influenza and other respiratory system conditions (GRD 89 and GRD 101). A total of 728 confirmed influenza cases were recorded: 52.9% were male, 46.7% were aged 75-84 years, and 49.3% received influenza vaccine ≥15 d prior to hospital admission. Influenza-related mean hospitalization costs (MHC) were € 1,184,808 in unvaccinated and € 1,152,333 in vaccinated cases (2.75% lower). Influenza vaccination showed significant protection against ICU admission (OR 0.35, 95%CI 0.21-0.59; p < 0001); mechanical ventilation (OR 0.56, 95%CI 0.39-0.80; p = 0.002); secondary bacterial pneumonia (OR 0.61, 95%CI 0.39-0.98; p = 0.04) and a higher degree of dependence (OR 0.74, 95%CI 0.55-0.99; p = 0.04). No association was observed for the Charlson comorbidity index or the mean hospital stay. Although influenza vaccination of the elderly may not achieve significant savings in mean hospitalization costs, it may lessen the degree of severity and avoid complications.

A six-month Serratia marcescens outbreak in a Neonatal Intensive Care Unit / Brote epidémico por Serratia marcescens en una Unidad de Cuidados Intensivos Neonatales

OBJECTIVE: To investigate a Serratia marcescens (S. marcescens) outbreak in a Neonatal Unit in a tertiary university hospital. METHODS: Descriptive study of children admitted to the Unit with S. marcescens infection from November 2012 to March 2013. Conventional microbiological methods for clinical and environmental samples were used. The clonal relationship between all available isolates was established by molecular methods. A multidisciplinary team was formed, and preventive measures were taken. RESULTS: S. marcescens was isolated from 18 children. The overall attack rate was 12%, and the case fatality rate in the Intensive Care Unit was 23.5%. The most prevalent types of infections were pneumonia (6), conjunctivitis (6), and bloodstream infection (5). Clinical isolates and environmental isolates obtained from an incubator belonged to a unique clone. The clonal relationship between all S. marcescens strains helped us to identify the possible source of the outbreak. CONCLUSION: Isolation of S. marcescens from stored water in a container, and from the surface of an incubator after cleaning, suggests a possible environmental source as the outbreak origin, which has been perpetuated due to a failure of cleaning methods in the Unit. The strict hygiene and cleaning measures were the main factors that contributed to the end of the outbreak

OBJETIVO: Investigar un brote por Serratia marcescens (S. marcescens) en una unidad de neonatología en un hospital universitario de tercer nivel. MÉTODO: Estudio descriptivo de los pacientes ingresados en la Unidad de noviembre de 2012 a marzo de 2013. Se usaron métodos microbiológicos convencionales de muestras clínicas y ambientales. La relación clonal de los aislados disponibles se llevó a cabo mediante estudio molecular. Se formó un equipo multidisciplinar a partir del cual se tomaron las medidas preventivas. RESULTADOS: Se aisló S. marcescens en 18 niños. La tasa global de ataque fue del 12% y la letalidad en la Unidad de Cuidados Intensivos llegó al 23,5%. Los tipos de infección más frecuentes fueron la neumonía (6), conjuntivitis (6) y bacteriemia (5). Tanto las muestras clínicas como las ambientales obtenidas de una incubadora pertenecían a un único clon. La relación clonal entre todas las cepas de S. marcescens permitió identificar la posible fuente de infección del brote. CONCLUSIÓN: El aislamiento de S. marcescens en agua almacenada en un contenedor y en la superficie de una incubadora tras su limpieza sugiere una posible fuente ambiental como el origen del brote, perpetuado por fallos en los métodos de limpieza en la Unidad. El cumplimiento estricto de la higiene de manos y mejora en la limpieza fueron los principales factores que contribuyeron a la finalización del brote

A six-month Serratia marcescens outbreak in a Neonatal Intensive Care Unit.

OBJECTIVE: To investigate a Serratia marcescens (S. marcescens) outbreak in a Neonatal Unit in a tertiary university hospital. METHODS: Descriptive study of children admitted to the Unit with S. marcescens infection from November 2012 to March 2013. Conventional microbiological methods for clinical and environmental samples were used. The clonal relationship between all available isolates was established by molecular methods. A multidisciplinary team was formed, and preventive measures were taken. RESULTS: S. marcescens was isolated from 18 children. The overall attack rate was 12%, and the case fatality rate in the Intensive Care Unit was 23.5%. The most prevalent types of infections were pneumonia (6), conjunctivitis (6), and bloodstream infection (5). Clinical isolates and environmental isolates obtained from an incubator belonged to a unique clone. The clonal relationship between all S. marcescens strains helped us to identify the possible source of the outbreak. CONCLUSION: Isolation of S. marcescens from stored water in a container, and from the surface of an incubator after cleaning, suggests a possible environmental source as the outbreak origin, which has been perpetuated due to a failure of cleaning methods in the Unit. The strict hygiene and cleaning measures were the main factors that contributed to the end of the outbreak.