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Implications of ad-hoc molecular typing for infection control measures in a multi-cluster, multi-phenotypic Serratia

M M A Toorop1, I V Hoogendijk1, H C M Dogterom-Ballering1

  • 1Leiden University Center for Infectious Diseases (LU-CID) Medical Microbiology and Infection Control, Leiden University Medical Center, Leiden, The Netherlands.

The Journal of Hospital Infection
|May 23, 2024
PubMed
Abstract

Insights

Core-genome multi-locus sequence typing (cgMLST) rapidly identified the source and spread of Serratia marcescens during a neonatal intensive care unit outbreak. This enabled quicker, evidence-based infection control decisions.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Genomics

Background:

  • Serratia marcescens outbreaks pose significant risks in neonatal intensive care units (NICUs).
  • Traditional methods for tracking outbreaks, like epidemiological data and antimicrobial resistance patterns, may not provide sufficient detail.
  • Whole-genome sequencing (WGS) technologies, including core-genome multi-locus sequence typing (cgMLST), offer enhanced resolution for outbreak investigations.

Purpose of the Study:

  • To employ cgMLST for detailed insights into the source and transmission dynamics of Serratia marcescens during a NICU outbreak.
  • To facilitate more effective and timely infection prevention and control strategies.

Main Methods:

  • Collected Serratia marcescens isolates from neonates in a NICU during an outbreak (September 2023 - January 2024).
  • Performed environmental sampling to identify potential common sources.
  • Conducted antibiotic susceptibility testing and analyzed antimicrobial resistance genes.
  • Utilized cgMLST for molecular typing of bacterial isolates.

Main Results:

  • cgMLST analysis of 17 patient isolates revealed five distinct complex types, forming four separate clusters.
  • The clustered nature of isolates suggested against a single, persistent environmental source, allowing for prompt de-escalation of infection control measures.
  • Observed variations in aminoglycoside resistance patterns within the same complex types and patient groups.

Conclusions:

  • Ad-hoc cgMLST provided crucial, timely data for informed decision-making during the Serratia marcescens NICU outbreak.
  • Antimicrobial phenotyping alone was insufficient for characterizing clonal spread in this specific outbreak scenario.
Keywords:
Core-genome multi-locus sequence typing (cgMLST)Intensive care unitMolecular typingNeonatal intensive care unitOutbreakSerratia marcescensWhole-genome sequencing

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