title: An outbreak of Serratia marcescens bacteremia after general anesthesia.
abstract: OBJECTIVE
  To investigate an outbreak of Serratia marcescens bacteremia among patients after general anesthesia.
  
  
  METHODS
  A case-control study.
  
  
  METHODS
  A 304-bed, pediatric teaching hospital.
  
  
  METHODS
  Twenty-three pediatric patients who developed S. marcescens bacteremia within 2 weeks after general anesthesia between June 15 and September 22, 1999, were compared with 46 age-matched control-patients who had undergone procedures on the same clinical services of the hospital during the same period.
  
  
  RESULTS
  Cases were distributed over a wide range of surgical services and were not correlated with exposure to any of the surgical, anesthesia, or nursing staff. Case-patients were significantly more likely than control-patients to have received cefazolin (odds ratio [OR], 11.1; 90% confidence interval [CI90], 1.9 to 24.3) or to have had perioperative placement of a central vascular catheter (OR, 4.2; CI90, 1.2 to 18.8). The timing of the procedures of patients who subsequently developed S. marcescens bacteremia was significantly associated with the shifts of one or more of five operating room technicians (OR, 2.9 to 6.8) who were responsible for preparing intravenous fluids used both to reconstitute perioperatively administered antibiotics and to prime central vascular catheter assemblies.
  
  
  CONCLUSIONS
  Our findings are consistent with a pattern of intermittent contamination due to periodic breaches in sterile technique, rather than a point-source of contamination. The unique challenges that such a procedural breakdown presents to an epidemiologic investigation are discussed. This outbreak stresses the importance of providing comprehensive training in antisepsis when multifunctional personnel are incorporated into an operating room work environment.
authors.affiliation: Division of Immunologic and Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Sebert
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Manning
authors.forename: Karin L
authors.initials: KL
authors.lastname: McGowan
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
authors.forename: Louis M
authors.initials: LM
authors.lastname: Bell
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data; D009872:Operating Room Technicians / Q000592:standards / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D016868:Serratia Infections / Q000453:epidemiology* / Q000382:microbiology; D012706:Serratia marcescens / Q000302:isolation & purification*; D017678:Sex Distribution; D013242:Sterilization / Q000592:standards