SERRATIA MARCESCENS IN THE INTENSIVE CARE NURSERY (ICN) AND ITS CONTROL

Abstract

During March through July, 1976, an outbreak of Serratia Marcescens was studied in our ICN to determine the clinical course and epidemiology of 23 culture positive infants. Cultures were obtained from the environment, cord, stool, and pharynx of all infants born in the nursery during the outbreak, and hand-washings, nasopharynx and vagina and/or rectum of all nursery personnel. Environmental cultures were negative, but 4 of 76 handwashings were positive after provodine-iodine scrubbing. Eleven symptomatic infections were recognized. Six positive cultures were obtained from blood, 2 from cerebrospinal fluid, 1 from peritoneal fluid, 3 from urine, and 1 from eye drainage. There were 5 probable cases of pneumonia. Serratia contributed to 2 deaths. Twelve infants were colonized but asymptomatic. Septic infants presented with a typical clinical picture of food intolerance, abdominal distention, tremors of the upper extremities and vasoconstriction. A study was performed using as controls infants brought into the ICN immediately before and after the culture positive infants. Significant factors were respirator care (p< .001), hyperalimentation (p< .001), multiple antibiotics (p< .001), and length of hospital stay (p< .001). The bacteria had the same serotype and characteristic antiobiogram (resistant to all antibiotics except chloramphenicol and amikacin). Spread was controlled by strict cohorting.