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An Outbreak of Serratia marcescens Bacteremia After General Anesthesia

Published online by Cambridge University Press:  02 January 2015

Michael E. Sebert ,
Mary Lou Manning ,
Karin L. McGowan ,
Elizabeth R. Alpern  and
Louis M. Bell
Michael E. Sebert
Affiliation:
Division of Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Mary Lou Manning
Affiliation:
Department of Infection Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Karin L. McGowan
Affiliation:
Division of Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Elizabeth R. Alpern
Affiliation:
Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Louis M. Bell*
Affiliation:
Division of Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Infection Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
*
Department of Pediatrics, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104
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Abstract

Objective:

To investigate an outbreak of Serratia marcescens bacteremia among patients after general anesthesia.

Design:

A case-control study.

Setting:

A 304-bed, pediatric teaching hospital.

Patients:

Twenty-three pediatric patients who developed S. marcescens bacteremia within 2 weeks after general anesthesia between June 15 and September 22, 1999, were compared with 46 age-matched control-patients who had undergone procedures on the same clinical services of the hospital during the same period.

Results:

Cases were distributed over a wide range of surgical services and were not correlated with exposure to any of the surgical, anesthesia, or nursing staff. Case-patients were significantly more likely than control-patients to have received cefazolin (odds ratio [OR], 11.1; 90% confidence interval [CI90], 1.9 to 24.3) or to have had perioperative placement of a central vascular catheter (OR, 4.2; CI90, 1.2 to 18.8). The timing of the procedures of patients who subsequently developed S. marcescens bacteremia was significantly associated with the shifts of one or more of five operating room technicians (OR, 2.9 to 6.8) who were responsible for preparing intravenous fluids used both to reconstitute perioperatively administered antibiotics and to prime central vascular catheter assemblies.

Conclusions:

Our findings are consistent with a pattern of intermittent contamination due to periodic breaches in sterile technique, rather than a point-source of contamination. The unique challenges that such a procedural breakdown presents to an epidemiologic investigation are discussed. This outbreak stresses the importance of providing comprehensive training in antisepsis when multifunctional personnel are incorporated into an operating room work environment.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 12 , December 2002 , pp. 733 - 739
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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