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Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1996 Dec;34(12):3138–3141. doi: 10.1128/jcm.34.12.3138-3141.1996

Use of pulsed-field gel electrophoresis typing to study an outbreak of infection due to Serratia marcescens in a neonatal intensive care unit.

G Miranda 1, C Kelly 1, F Solorzano 1, B Leanos 1, R Coria 1, J E Patterson 1
PMCID: PMC229471  PMID: 8940460

Abstract

Serratia marcescens is a well-known cause of nosocomial infections and outbreaks, particularly in critically ill neonates and immunocompromised patients. Numerous methods have been proposed for typing. We used pulsed-field gel electrophoresis (PFGE) typing to analyze an outbreak in a neonatal intensive care unit (NICU). We included 23 patient isolates from an outbreak (March to July 1995), and 10 patient isolates from different wards during the same time period. PFGE of whole-cell DNA digested by SpeI was used as a marker of strain identity. The most common presentation of the infection was sepsis in 18 of 23 (78%) neonates. Only four different biotypes were identified; biotype A8d accounted for 84% of the strains. PFGE typing revealed two clones responsible for two different clonal strain dissemination outbreaks from March to July, with 24 patient isolates being pattern A and 4 patient isolates being pattern E. PFGE typing suggests cross transmission between patients in the NICU and other wards. The isolates from 5 other patients showed distinct PFGE patterns. Extensive investigation and cultures failed to identify any environmental or staff reservoir of S. marcescens. This is one of the first reports applying PFGE to the study of S. marcescens, and this method was a useful marker of strain identity. PFGE typing distinguished strains which appeared to be the same by biotyping.

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Selected References

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  1. Acar J. F. Serratia marcescens infections. Infect Control. 1986 May;7(5):273–278. doi: 10.1017/s0195941700064201. [DOI] [PubMed] [Google Scholar]
  2. Alonso R., Aucken H. M., Perez-Diaz J. C., Cookson B. D., Baquero F., Pitt T. L. Comparison of serotype, biotype and bacteriocin type with rDNA RFLP patterns for the type identification of Serratia marcescens. Epidemiol Infect. 1993 Aug;111(1):99–107. doi: 10.1017/s0950268800056727. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bale M., Sanford M., Hollis R., Pfaller M. A. Application of a biotyping system and DNA restriction fragment analysis to the study of Serratia marcescens from hospitalized patients. Diagn Microbiol Infect Dis. 1993 Jan;16(1):1–7. doi: 10.1016/0732-8893(93)90123-o. [DOI] [PubMed] [Google Scholar]
  4. Bingen E. H., Mariani-Kurkdjian P., Lambert-Zechovsky N. Y., Desjardins P., Denamur E., Aujard Y., Vilmer E., Elion J. Ribotyping provides efficient differentiation of nosocomial Serratia marcescens isolates in a pediatric hospital. J Clin Microbiol. 1992 Aug;30(8):2088–2091. doi: 10.1128/jcm.30.8.2088-2091.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bollmann R., Halle E., Sokolowska-Köhler W., Grauel E. L., Buchholz P., Klare I., Tschäpe H., Witte W. Nosocomial infections due to Serratia marcescens--clinical findings, antibiotic susceptibility patterns and fine typing. Infection. 1989 Sep-Oct;17(5):294–300. doi: 10.1007/BF01650711. [DOI] [PubMed] [Google Scholar]
  6. Christensen G. D., Korones S. B., Reed L., Bulley R., McLaughlin B., Bisno A. L. Epidemic Serratia marcescens in a neonatal intensive care unit: importance of the gastrointestinal tract as a reservoir. Infect Control. 1982 Mar-Apr;3(2):127–133. doi: 10.1017/s0195941700055909. [DOI] [PubMed] [Google Scholar]
  7. Coria-Jiménez R., Ortiz-Torres C. Aminoglycoside resistance patterns of Serratia marcescens strains of clinical origin. Epidemiol Infect. 1994 Feb;112(1):125–131. doi: 10.1017/s0950268800057484. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Coria-Jiménez V. R., Villa-Tanaka L., Ortíz-Torres C. Partial characterization of Serratia marcescens nosocomial strains. Arch Invest Med (Mex) 1991 Jul-Dec;22(3-4):273–278. [PubMed] [Google Scholar]
  9. Grimont P. A., Grimont F. Biotyping of Serratia marcescens and its use in epidemiological studies. J Clin Microbiol. 1978 Jul;8(1):73–83. doi: 10.1128/jcm.8.1.73-83.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Grimont P. A., Grimont F., Le Minor S., Davis B., Pigache F. Compatible results obtained from biotyping and serotyping in Serratia marcescens. J Clin Microbiol. 1979 Oct;10(4):425–432. doi: 10.1128/jcm.10.4.425-432.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hammer H. Serratia marcescens auf einer Neugeborenenintensivstation--Eine 5-Jahres-Analyse. Padiatr Grenzgeb. 1984;23(5):299–303. [PubMed] [Google Scholar]
  12. Hartstein A. I., Morthland V. H., Rourke J. W., Sykes R., Rashad A. L. Plasmid DNA analysis, biotyping, and antimicrobic susceptibility as subtyping tests for Klebsiella pneumoniae and Klebsiella oxytoca. Diagn Microbiol Infect Dis. 1993 Jan;16(1):35–41. doi: 10.1016/0732-8893(93)90128-t. [DOI] [PubMed] [Google Scholar]
  13. Larose P., Picard B., Thibault M., Grimont F., Goullet P. Nosocomial Serratia marcescens individualized by five typing methods in a regional hospital. J Hosp Infect. 1990 Feb;15(2):167–172. doi: 10.1016/0195-6701(90)90126-9. [DOI] [PubMed] [Google Scholar]
  14. Liu P. Y., Lau Y. J., Hu B. S., Shir J. M., Cheung M. H., Shi Z. Y., Tsai W. S. Use of PCR to study epidemiology of Serratia marcescens isolates in nosocomial infection. J Clin Microbiol. 1994 Aug;32(8):1935–1938. doi: 10.1128/jcm.32.8.1935-1938.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. McGeer A., Low D. E., Penner J., Ng J., Goldman C., Simor A. E. Use of molecular typing to study the epidemiology of Serratia marcescens. J Clin Microbiol. 1990 Jan;28(1):55–58. doi: 10.1128/jcm.28.1.55-58.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Montanaro D., Grasso G. M., Annino I., De Ruggiero N., Scarcella A., Schioppa F. Epidemiological and bacteriological investigation of Serratia marcescens epidemic in a nursery and in a neonatal intensive care unit. J Hyg (Lond) 1984 Aug;93(1):67–78. doi: 10.1017/s0022172400060940. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Newport M. T., John J. F., Michel Y. M., Levkoff A. H. Endemic Serratia marcescens infection in a neonatal intensive care nursery associated with gastrointestinal colonization. Pediatr Infect Dis. 1985 Mar-Apr;4(2):160–167. doi: 10.1097/00006454-198503000-00010. [DOI] [PubMed] [Google Scholar]
  18. Sifuentes-Osornio J., Ruiz-Palacios G. M., Gröschel D. H. Analysis of epidemiologic markers of nosocomial Serratia marcescens isolates with special reference to the Grimont biotyping system. J Clin Microbiol. 1986 Feb;23(2):230–234. doi: 10.1128/jcm.23.2.230-234.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Simor A. E., Ramage L., Wilcox L., Bull S. B., Bialkowska-Hobrzanska H. Molecular and epidemiologic study of multiresistant Serratia marcescens infections in a spinal cord injury rehabilitation unit. Infect Control. 1988 Jan;9(1):20–27. [PubMed] [Google Scholar]
  20. Smith P. J., Brookfield D. S., Shaw D. A., Gray J. An outbreak of Serratia marcescens infections in a neonatal unit. Lancet. 1984 Jan 21;1(8369):151–153. doi: 10.1016/s0140-6736(84)90074-6. [DOI] [PubMed] [Google Scholar]
  21. Sokalski S. J., Jewell M. A., Asmus-Shillington A. C., Mulcahy J., Segreti J. An outbreak of Serratia marcescens in 14 adult cardiac surgical patients associated with 12-lead electrocardiogram bulbs. Arch Intern Med. 1992 Apr;152(4):841–844. [PubMed] [Google Scholar]
  22. Tenover F. C., Arbeit R. D., Goering R. V., Mickelsen P. A., Murray B. E., Persing D. H., Swaminathan B. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995 Sep;33(9):2233–2239. doi: 10.1128/jcm.33.9.2233-2239.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Villarino M. E., Jarvis W. R., O'Hara C., Bresnahan J., Clark N. Epidemic of Serratia marcescens bacteremia in a cardiac intensive care unit. J Clin Microbiol. 1989 Nov;27(11):2433–2436. doi: 10.1128/jcm.27.11.2433-2436.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wake C., Lees H., Cull A. B. The emergence of Serratia marcescens as a pathogen in a newborn unit. Aust Paediatr J. 1986 Nov;22(4):323–326. doi: 10.1111/j.1440-1754.1986.tb02158.x. [DOI] [PubMed] [Google Scholar]
  25. Zaidi M., Sifuentes J., Bobadilla M., Moncada D., Ponce de León S. Epidemic of Serratia marcescens bacteremia and meningitis in a neonatal unit in Mexico City. Infect Control Hosp Epidemiol. 1989 Jan;10(1):14–20. doi: 10.1086/645909. [DOI] [PubMed] [Google Scholar]

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