title: Extended-spectrum beta-lactamase-producing Serratia marcescens outbreak in a Bulgarian hospital.
abstract: We describe a nosocomial outbreak of extended-spectrum beta-lactamase (ESBL)-producing Serratia marcescens in a Bulgarian university hospital affecting nine patients on four wards. Phenotypic and genotypic (plasmid profile, randomly amplified polymorphic DNA analysis and amplified ribosomal DNA restriction analysis) analysis of the isolates indicated a single clone. The epidemic strain was resistant to oxyimino beta-lactams, aztreonam, aminoglycosides, tetracycline and chloramphenicol. It produced CTX-M-3 ESBL as demonstrated by isoelectric focusing, CTX-M PCR-RFLP and gene sequencing. The isolate was also found in the environment and from a nurse's hands, suggesting transmission by staff handling. The outbreak was controlled by patient isolation and intensified hand washing. This is the first report from Bulgaria describing a hospital outbreak caused by CTX-M-3 ESBL-producing S. marcescens.
authors.affiliation: Second Multiprofile Active Treatment Hospital, Sofia, Bulgaria. micro_vtora.mbal@abv.bg
authors.forename: D
authors.initials: D
authors.lastname: Ivanova
authors.forename: R
authors.initials: R
authors.lastname: Markovska
authors.forename: N
authors.initials: N
authors.lastname: Hadjieva
authors.forename: I
authors.initials: I
authors.lastname: Schneider
authors.forename: I
authors.initials: I
authors.lastname: Mitov
authors.forename: A
authors.initials: A
authors.lastname: Bauernfeind
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques; D002031:Bulgaria / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D016172:DNA Fingerprinting / Q000379:methods; D004269:DNA, Bacterial / Q000235:genetics; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D004783:Environmental Microbiology; D005838:Genotype; D006225:Hand / Q000382:microbiology; D006235:Hand Disinfection; D006761:Hospitals; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient; D007525:Isoelectric Focusing; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009726:Nurses; D010356:Patient Isolation; D010957:Plasmids; D016868:Serratia Infections / Q000145:classification / Q000453:epidemiology* / Q000382:microbiology*; D012706:Serratia marcescens / Q000201:enzymology* / Q000302:isolation & purification; D001618:beta-Lactamases / Q000737:chemistry / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D001618:beta-Lactamases