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Outbreak of Invasive Serratia marcescens among Persons Incarcerated in a State Prison, California, USA, March
Abstract:
Serratia marcescens is an environmental gram-negative bacterium that causes invasive disease in rare cases. During 2020-2022, an outbreak of 21 invasive Serratia infections occurred in a prison in California, USA. Most (95%) patients had a history of recent injection drug use (IDU). We performed whole-genome sequencing and found isolates from 8 patients and 2 pieces of IDU equipment were closely related. We also identified social interactions among patients. We recovered S. marcescens from multiple environmental samples throughout the prison, including personal containers storing Cell Block 64 (CB64), a quaternary ammonium disinfectant solution. CB64 preparation and storage conditions were suboptimal for S. marcescens disinfection. The outbreak was likely caused by contaminated CB64 and propagated by shared IDU equipment and social connections. Ensuring appropriate preparation, storage, and availability of disinfectants and enacting interventions to counteract disease spread through IDU can reduce risks for invasive Serratia infections in California prisons.
Insights
An outbreak of Serratia infections in a California prison was linked to contaminated disinfectant and spread through shared injection drug equipment and social ties. Improved disinfectant practices and interventions are crucial to prevent future outbreaks.
Area of Science:
- Infectious Disease Epidemiology
- Microbiology
- Public Health
Background:
- Serratia marcescens is an environmental bacterium rarely causing invasive disease.
- An outbreak of 21 invasive Serratia infections occurred in a California prison between 2020-2022.
- Most patients (95%) had a history of recent injection drug use (IDU).
Purpose of the Study:
- To investigate the cause and transmission dynamics of an invasive Serratia marcescens outbreak in a correctional facility.
- To identify the source of infection and contributing factors to disease spread.
Main Methods:
- Whole-genome sequencing of bacterial isolates from patients and IDU equipment.
- Environmental sampling to identify S. marcescens reservoirs.
- Analysis of patient social interactions and disinfectant usage.
Main Results:
- Closely related S. marcescens isolates were found in patients and IDU equipment.
- S. marcescens was recovered from personal containers of a quaternary ammonium disinfectant (CB64).
- Suboptimal preparation and storage of CB64 likely contributed to contamination.
Conclusions:
- The outbreak was likely caused by contaminated CB64, with spread facilitated by shared IDU equipment and social connections.
- Ensuring proper disinfectant preparation, storage, and availability is essential.
- Interventions targeting disease spread through IDU are needed to reduce invasive Serratia risks in prisons.
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