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Clinical, epidemiologic and microbiologic features of a persistent outbreak of amikacin-resistant Serratia marcescens
Abstract:
This article describes a prolonged outbreak (January 1977 to February 1980) of amikacin-resistant Serratia marcescens (ARSM) urinary infections and the methods used for its control. Significant factors predisposing to ARSM urinary tract infection included an extended hospital stay, being in the urology ward, and undergoing urologic surgery. There had been on prior administration of amikacin or of other aminoglycosides in 20 of 27 patients with ARSM urinary tract infections. Chronically infected patients who required multiple hospitalizations represented a major reservoir for the perpetuation of the outbreak, overshadowing the importance of aminoglycoside use. Traditional control measures and even a major change in the inanimate environment were only partially effective in controlling the outbreak, but treatment of bacteriuric patients in the urology unit with "second and third generation" cephalosporins interrupted patient-to-patient transmission. No new cases of ARSM bacteriuria appeared in the urology unit in the ensuing 12 months.
Insights
A prolonged outbreak of amikacin-resistant Serratia marcescens (ARSM) urinary infections was controlled by treating patients with cephalosporins. Chronically infected individuals were identified as a key reservoir for ARSM perpetuation.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- A prolonged outbreak of amikacin-resistant Serratia marcescens (ARSM) urinary infections occurred between January 1977 and February 1980.
- Factors predisposing to ARSM urinary tract infection included extended hospital stays, urology ward residence, and urologic surgery.
Purpose of the Study:
- To describe the prolonged outbreak of ARSM urinary infections.
- To identify methods for controlling the ARSM outbreak.
Main Methods:
- Retrospective analysis of patient data during the outbreak period.
- Evaluation of traditional control measures and environmental changes.
- Implementation of second and third-generation cephalosporin treatment for bacteriuric patients.
Main Results:
- Chronically infected patients requiring multiple hospitalizations were a major reservoir for ARSM perpetuation.
- Traditional control measures and environmental modifications had limited success.
- Treatment with second and third-generation cephalosporins effectively interrupted patient-to-patient transmission.
Conclusions:
- Targeted antibiotic therapy, specifically with cephalosporins, was crucial in controlling the ARSM outbreak.
- Interruption of patient-to-patient transmission was achieved by treating bacteriuric patients.
- No new cases of ARSM bacteriuria were observed in the urology unit for 12 months post-intervention.