Serratia marcescens Bacteremia Traced to an Infused Narcotic

• Published in: The New England journal of medicine Vol. 346; no. 20; pp. 1529 - 1537
• Main Authors: Ostrowsky, Belinda E, Whitener, Cynthia, Bredenberg, Helen K, Carson, Loretta A, Holt, Stacey, Hutwagner, Lori, Arduino, Matthew J, Jarvis, William R
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 16.05.2002
• Subjects: Allied Health Personnel; Bacteremia - epidemiology; Bacteremia - microbiology; Bacterial diseases; Biological and medical sciences; Disease Outbreaks; Enterobacter cloacae - isolation & purification; Equipment Contamination; Fentanyl - administration & dosage; Fentanyl - analysis; Hair - chemistry; Hospitals; Human bacterial diseases; Humans; Infectious Disease Transmission, Professional-to-Patient; Infectious diseases; Infusions, Parenteral - instrumentation; Intensive care; Intensive Care Units; Male; Medical sciences; Microbiology; Miscellaneous; Multivariate Analysis; Narcotics - administration & dosage; Narcotics - analysis; Opioid-Related Disorders; Respiratory Therapy; Risk Factors; Serratia Infections - epidemiology; Serratia Infections - microbiology; Serratia Infections - transmission; Serratia marcescens - genetics; Serratia marcescens - isolation & purification; Epidemic; Human; Nosocomial infection; Drug addiction; Health staff; Fentanyl; Opiates; Narcotic analgesic; Bacteremia; Contamination; Intensive care unit; Infection; Surgery; Serratia marcescens; Bacteriosis; Bacteria; Enterobacteriaceae
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa012370

An outbreak of Serratia marcescens bacteremia among patients in a surgical intensive care unit was extensively investigated. A total of 26 infected patients were identified. In a case–control study, the main risk factors were receipt of continuous fentanyl infusions and exposure to two specific respiratory therapists. Isolates from the patients were similar to isolates from the infused medication. Serratia marcescens has been implicated as a pathogen in a large array of infections. 1 Nosocomial S. marcescens outbreaks have been associated with contaminated equipment, such as transducers 2 , 3 and bronchoscopic equipment 4 ; contaminated fluids and cleaning solutions 5 – 7 ; contaminated hands or fingernails of employees 8 ; and a reduced nurse-to-patient ratio. 9 From June 30 through September 30, 1998, nine cases of S. marcescens bacteremia were detected in the surgical intensive care unit of a 455-bed tertiary care facility. Because of the rarity of serratia species in clinical specimens and the similar antimicrobial-susceptibility patterns in these cases, eight of the nine . . .