The Outbreak of Se"atia marcescens Bacteremia *IDa Pediatric Ward, Siriraj Hospital 1997
KULKANYA CHOKEPHAIBULKIT, M.D.*, SOMWANG DANCHAIVUITR, M.D.**,
GORAPIN BOONPRAGAIGAEW, M.D.*, CHERTSAK DHIRAPUTRA, M.D.***,
NIRUN VA NPRAPA, M.D.*, NUANANONG VISITSUNTHORN, M.D.*,
SUWANNA TRAKULSOMBOON, Ph.D.**
Affiliation : * Department of Pediatrics,
** Department of Internal Medicine,
***
Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
AbstractBetween October 20 and November 11, 1997, Serratia marcescens bacteremia was iden
tified in 8 patients in a pediatric ward at Siriraj Hospital. The organism was isolated from 17 blood
and 3 bone marrow specimens. The only common associated factor in these patients was that
they all had received an intravenous fluid infusion. In the attempt to investigate the source of
S.marcescens implicated in the outbreak,l08 specimens of intravenous fluid, 3 intravenous fluid
bottle caps, 4 specimens from intravenous fluid tubing sets, 21 specimens of antiseptics used on
the ward, 28 specimens of rectal swabs from patients on the ward, 1 sample of blood culture media
prepared by the hospital for routine use, and 62 environmental specimens including hand swabs of
the medical personnel, refrigerator, air conditioning, milk samples, room air, water sink, wooden
splint and adhesive tape used to immobilize the intravenous access. Of 227 specimens sent for
culture, S.marcescens was isolated from only one specimen collected from the in-use intravenous
fluid given to a patient with Serratia bacteremia. S.marcescens was not found in any other surveil
lance culture. The 8 patients were placed under quarantine in the same room with an exclusive
nursing team. With the investigation and intervention including monitoring for meticulous hand
washing of the ward staff, the outbreak was stopped within 7 days. Although the investigation failed
to discover the environmental reservoir of S.marcescens in this outbreak, the data suggested that
intravenous fluid was probably the route of transmission and the medical personnel played an
important role in spreading the infection.
Keywords : Serratia Marcescens, Outbreak, Bacteremia, Children, Nosocomial Infection
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