title: Outbreak of Serratia marcescens postsurgical bloodstream infection due to contaminated intravenous pain control fluids.
abstract: BACKGROUND
  Serratia marcescens is an important nosocomial pathogen causing significant outbreaks. Here we report an outbreak of bloodstream infection caused by S. marcescens at a 3500-bed hospital in Taiwan. The effective cooperative efforts of both laboratory personnel and infection control practitioners (ICPs) jointly contributed to the total control of the outbreak.
  
  
  METHODS
  A sudden increase in the isolation of S. marcescens from blood cultures was noted in the Clinical Microbiology Laboratory. The information was passed to the ICPs and an investigation was initiated. Pulsed-field gel electrophoresis was used to study the relationships among the isolates.
  
  
  RESULTS
  Pulsotype A was identified in 43 (82.7%) of the 52 blood isolates studied. They were isolated from 52 patients distributed across 22 wards that were surveyed by seven ICPs. All patients had undergone surgery before the infection, and fentanyl-containing intravenous fluids were used for pain control in 43 of them. Isolates from 42 belonged to pulsotype A. Three S. marcescens isolates, all from fentanyl-containing fluids and demonstrating pulsotype A, were identified from 251 environmental cultures. All fentanyl-containing fluids that were in use were withdrawn and the outbreak was stopped.
  
  
  CONCLUSIONS
  The outbreak of S. marcescens bloodstream infection apparently occurred through the use of fentanyl-containing fluids contaminated by a pulsotype A S. marcescens.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Kweishan, Taoyuan, Taiwan.
authors.forename: Ping-Cherng
authors.initials: PC
authors.lastname: Chiang
authors.forename: Tsu-Lan
authors.initials: TL
authors.lastname: Wu
authors.forename: An-Jing
authors.initials: AJ
authors.lastname: Kuo
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.forename: Ting-Ying
authors.initials: TY
authors.lastname: Chung
authors.forename: Chun-Sui
authors.initials: CS
authors.lastname: Lin
authors.forename: Hsieh-Shong
authors.initials: HS
authors.lastname: Leu
authors.forename: Lin-Hui
authors.initials: LH
authors.lastname: Su
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology*; D004196:Disease Outbreaks; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D016868:Serratia Infections / Q000453:epidemiology*; D012706:Serratia marcescens / Q000302:isolation & purification*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: Bloodstream infection; Contaminated intravenous fluids; Fentanyl; Postsurgical infection; Serratia marcescens