title: Investigation of an outbreak of Serratia marcescens in a neonatal intensive care unit.
abstract: BACKGROUND
  Serratia marcescens is a well-known but relatively uncommon cause of nosocomial infections, particularly in neonatal intensive care unit (NICU) patients. We investigated an outbreak of S marcescens in the NICU at the Farabi Hospital of Karadeniz Technical University in Trabzon, Turkey.
  
  
  METHODS
  Between March 21 and May 27, 2006, nine of the neonates were identified with cultures of S marcescens, and there were three deaths because of septicemia. For the purpose of identifying the source of infection, 85 environmental samples, two breast milk samples from two babies' mothers, and 38 hand-washing samples from the health care workers (HCWs) were collected for the detection of S marcescens. All the S marcescens isolates were genotyped by pulsed-field gel electrophoresis with endonuclease SpeI restriction enzyme.
  
  
  RESULTS
  Serratia marcescens was identified from one hand-washing sample and two breast milk samples. None of the environmental samples yielded S marcescens. Of the 13 isolates analyzed, four belonged to one major genotype, whereas eight (6 from neonates and 2 from breast milk) were indistinguishable; two isolates (2 from neonates) were closely related; and three isolates (2 other neonates and 1 from HCW's hand) were different. Our intensive efforts failed to determine the source of the outbreak despite the finding that S marcescens strain was isolated from a HCW's hand.
  
  
  CONCLUSIONS
  Present investigation suggested that an outbreak of S marcescens infection was caused by a major clone in our NICU, possibly transmitted through the hands of HCWs, emphasizing that strict hand washing before and after contact with patients must be the rule of the thumb.
authors: Department of Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey. gulcinbay@hotmail.com
authors: Gulcin
authors: G
authors: Bayramoglu
authors: Kurtuluş
authors: K
authors: Buruk
authors: Ugur
authors: U
authors: Dinc
authors: Mehmet
authors: M
authors: Mutlu
authors: Gurdal
authors: G
authors: Yilmaz
authors: Yakup
authors: Y
authors: Aslan
mesh_terms: D015373:Bacterial Typing Techniques; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology*; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field / Q000379:methods; D005260:Female; D006235:Hand Disinfection; D006282:Health Personnel; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D007363:Intensive Care Units, Neonatal; D008895:Milk, Human / Q000382:microbiology; D016868:Serratia Infections / Q000175:diagnosis / Q000453:epidemiology*; D012706:Serratia marcescens / Q000145:classification / Q000302:isolation & purification*; D014421:Turkey / Q000453:epidemiology