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Genomic epidemiological analysis of a single-centre polyclonal outbreak of Serratia marcescens, Belgium, 2022 to 2023
Sam Van Goethem1,2, Basil Britto Xavier1,2, Youri Glupczynski1
1Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
Abstract:
Serratia marcescens is an opportunistic pathogen with a propensity to cause nosocomial outbreaks, particularly in neonatal intensive care units (NICUs). We present a sustained outbreak spanning over 18 months (1 January 2022-29 August 2023) in a NICU in Antwerp, Belgium, affecting 61 neonates, identified through samples taken for diagnostic purposes and by rectal screening. Ten neonates were infected: five with lower respiratory tract infection, four with conjunctivitis and one fatal case with sepsis. In a logistic regression analysis, nursing in an incubator was significantly associated with acquisition of S. marcescens (odds ratio (OR): 2.99; 95% confidence interval (CI): 1.14-8.25; p < 0.05). Whole genome sequencing-based multilocus sequence typing (wgMLST) and core genome single nucleotide polymorphism (cgSNP) analysis of isolates from clinical (n = 4), screening (n = 52) and environmental samples (n = 8), identified eight clusters and five singletons not associated with the clusters. Although outbreak measures were successful in containing further spread within the ward during sudden surges when > 4 cases per week were identified (peak events), several peaks with different clonal clusters occurred. The emergence of similar outbreaks in Belgian hospitals underscores the need of continuous surveillance and NICU-specific infection prevention and control (IPC) measures.
Insights
A prolonged Serratia marcescens outbreak in a neonatal intensive care unit (NICU) affected 61 neonates. Incubator care was linked to acquisition, highlighting the need for NICU-specific infection control measures.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- Serratia marcescens is a significant opportunistic pathogen causing nosocomial infections.
- Neonatal intensive care units (NICUs) are particularly vulnerable to outbreaks.
Purpose of the Study:
- To investigate a sustained Serratia marcescens outbreak in a Belgian NICU.
- To identify risk factors and transmission dynamics of the outbreak.
Main Methods:
- Whole genome sequencing (wgMLST and cgSNP) was used for isolate analysis.
- Logistic regression identified risk factors for acquisition.
- Surveillance included diagnostic and rectal screening samples.
Main Results:
- The outbreak spanned 18 months, affecting 61 neonates with infections including respiratory, conjunctivitis, and sepsis.
- Incubator nursing was a significant risk factor (OR: 2.99).
- Genomic analysis revealed eight distinct clonal clusters and five singletons.
Conclusions:
- Continuous surveillance and NICU-specific infection prevention and control (IPC) are crucial.
- The outbreak demonstrated the challenge of containing Serratia marcescens in NICUs.
- Similar outbreaks in Belgium necessitate enhanced vigilance and control strategies.
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