A heterogeneous outbreak of Enterobacter cloacae and Serratia marcescens infections in a surgical intensive care unit

Grant Dorsey, Hena T. Borneo, Sumi J. Sun, Jennifer Wells, Lynn Steele, Kathryn Howland, Francoise Perdreau-Remington, David Bangsberg

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

OBJECTIVE: To investigate an outbreak of invasive disease due to Enterobacter cloacae and Serratia marcescens in a surgical intensive care unit (ICU). DESIGN: Pulsed-field gel electrophoresis (PFGE) analysis of restriction fragments was used to characterize the outbreak isolate genotypes. A retrospective cohort study of surgical ICU patients was conducted to identify risk factors associated with invasive disease. Unit staffing data were analyzed to compare staffing levels during the outbreak to those prior to and following the outbreak. SETTING: An urban hospital in San Francisco, California. PATIENTS: During the outbreak period, December 1997 through January 1998, there were 52 patients with a minimum ICU stay of ≥72 hours. Of these, 10 patients fit our case definition of recovery of E cloacae or S marcescens from a sterile site RESULTS: PFGE analysis revealed a highly heterogeneous population of isolates. Bivariate analysis of patient-related risk factors revealed duration of central lines, respiratory colonization, being a burn patient, and the use of gentamicin or nafcillin to be significantly associated with invasive disease. Both respiratory colonization and duration of central lines remained statistically significant in a multivariate analysis. Staffing data suggested a temporal correlation between understaffing and the outbreak period. CONCLUSIONS: Molecular epidemiological techniques provided a rapid means of ruling out a point source or significant cross-contamination as modes of transmission. In this setting, patient-related risk factors, such as respiratory colonization and duration of central lines, may provide a focus for heightened surveillance, infection control measures, and empirical therapy during outbreaks caused by common nosocomial pathogens. In addition, understaffing of nurses may have played a role in this outbreak, highlighting the importance of monitoring staffing levels.

Original languageEnglish (US)
Pages (from-to)465-469
Number of pages5
JournalInfection Control and Hospital Epidemiology
Volume21
Issue number7
StatePublished - 2000
Externally publishedYes

Fingerprint

Serratia Infections
Enterobacter cloacae
Serratia marcescens
Critical Care
Disease Outbreaks
Intensive Care Units
Pulsed Field Gel Electrophoresis
Nafcillin
Cloaca
San Francisco
Urban Hospitals
Infection Control
Gentamicins
Cohort Studies
Multivariate Analysis
Retrospective Studies
Nurses
Genotype

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology

Cite this

A heterogeneous outbreak of Enterobacter cloacae and Serratia marcescens infections in a surgical intensive care unit. / Dorsey, Grant; Borneo, Hena T.; Sun, Sumi J.; Wells, Jennifer; Steele, Lynn; Howland, Kathryn; Perdreau-Remington, Francoise; Bangsberg, David.

In: Infection Control and Hospital Epidemiology, Vol. 21, No. 7, 2000, p. 465-469.

Research output: Contribution to journalArticle

Dorsey, G, Borneo, HT, Sun, SJ, Wells, J, Steele, L, Howland, K, Perdreau-Remington, F & Bangsberg, D 2000, 'A heterogeneous outbreak of Enterobacter cloacae and Serratia marcescens infections in a surgical intensive care unit', Infection Control and Hospital Epidemiology, vol. 21, no. 7, pp. 465-469.
Dorsey, Grant ; Borneo, Hena T. ; Sun, Sumi J. ; Wells, Jennifer ; Steele, Lynn ; Howland, Kathryn ; Perdreau-Remington, Francoise ; Bangsberg, David. / A heterogeneous outbreak of Enterobacter cloacae and Serratia marcescens infections in a surgical intensive care unit. In: Infection Control and Hospital Epidemiology. 2000 ; Vol. 21, No. 7. pp. 465-469.
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AU - Dorsey, Grant

AU - Borneo, Hena T.

AU - Sun, Sumi J.

AU - Wells, Jennifer

AU - Steele, Lynn

AU - Howland, Kathryn

AU - Perdreau-Remington, Francoise

AU - Bangsberg, David

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N2 - OBJECTIVE: To investigate an outbreak of invasive disease due to Enterobacter cloacae and Serratia marcescens in a surgical intensive care unit (ICU). DESIGN: Pulsed-field gel electrophoresis (PFGE) analysis of restriction fragments was used to characterize the outbreak isolate genotypes. A retrospective cohort study of surgical ICU patients was conducted to identify risk factors associated with invasive disease. Unit staffing data were analyzed to compare staffing levels during the outbreak to those prior to and following the outbreak. SETTING: An urban hospital in San Francisco, California. PATIENTS: During the outbreak period, December 1997 through January 1998, there were 52 patients with a minimum ICU stay of ≥72 hours. Of these, 10 patients fit our case definition of recovery of E cloacae or S marcescens from a sterile site RESULTS: PFGE analysis revealed a highly heterogeneous population of isolates. Bivariate analysis of patient-related risk factors revealed duration of central lines, respiratory colonization, being a burn patient, and the use of gentamicin or nafcillin to be significantly associated with invasive disease. Both respiratory colonization and duration of central lines remained statistically significant in a multivariate analysis. Staffing data suggested a temporal correlation between understaffing and the outbreak period. CONCLUSIONS: Molecular epidemiological techniques provided a rapid means of ruling out a point source or significant cross-contamination as modes of transmission. In this setting, patient-related risk factors, such as respiratory colonization and duration of central lines, may provide a focus for heightened surveillance, infection control measures, and empirical therapy during outbreaks caused by common nosocomial pathogens. In addition, understaffing of nurses may have played a role in this outbreak, highlighting the importance of monitoring staffing levels.

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