Surto por Serratia marcescens produtora de β- lactamases de espectro extendido no berçário de alto risco (BAR) do Hospital De Clínicas Da Universidade Federal de Uberlândia (HC-UFU)

Abstract

It was reported one outbreak of infection and colonization due to Serratia marcescens involving 53 infants admitted to the High-Risk Nursery (HRN) of the Uberlândia Federal University Hospital, between december, 1997, and march 1998. Thirty-eight infants were colonized without clinical signs of infection and 15 infants had clinical disease.Five infants developed septicemia, seven infants developed conjunctivitis, 1 developed both sepsis and conjunctivitis, 1 infant developed otitis, and 1 infant had a urinary tract infection. On univariate analysis, independent risk factors for Serratia marcescens clinical disease were: low birth weight (<1.500g), incubator care, use of carbapenems, duration of hospitalization (> 7 days), low Apgar score, and prematurity. The epidemic strain had as main characteristic one resistance of ceftazidime, with CIMs90 > 32,0 pg/mL for ceftazidime and >16,0 pg/mL for cefepime. The production of ESBLs was demonstrated by the double disk diffusion test in the four isolates obtained from infected infants and in 30,2% of colonized infants. Cultures from the hands of health care professionals, soap samples, ventilator reservoirs and work and incubator surfaces failed to identify a reservoir of Serratia marcescens, but positive cultures were found in half of the sink drains. Containment of the outbreak was achieved by closure of the BAR new admissions, employment of strict hygienic measures, and careful nursing care of the infected and colonized infants. Rapid organism identification and initiation of control measures are important in containing such na epidemic at na early stage.