title: Late-onset neonatal sepsis, risk factors and interventions: an analysis of recurrent outbreaks of Serratia marcescens, 2006-2011.
abstract: BACKGROUND
  Between 2006 and 2011, 11 patients with Serratia marcescens sepsis and 47 patients colonized due to the spread of various clones were observed. These recurrent clusters brought about interventions to reduce spread between patients.
  
  
  OBJECTIVE
  To evaluate the effect of stepwise interventions to prevent S. marcescens colonization/sepsis and to analyse risk factors for late-onset sepsis (LOS).
  
  
  METHODS
  An open retrospective observational study was performed to evaluate the interventions. A retrospective case-control study was performed to analyse the risk factors for LOS.
  
  
  RESULTS
  S. marcescens sepsis and colonization decreased after the stepwise adoption of hygiene interventions. Low gestational age, low birth weight, indwelling central venous or umbilical catheter, and ventilator treatment were identified as risk factors for LOS. Compliance with basic hygiene guidelines was the only intervention monitored continuously from late 2007. Compliance increased gradually to a steady high level in early 2009. There was a decrease in S. marcescens LOS, clustering after the second quarter of 2008. After the first quarter of 2009, S. marcescens colonization decreased.
  
  
  CONCLUSIONS
  It was not possible to identify the specific effects of each intervention, but it is likely that an update of the hospital's antibiotic policy affected the occurrence of S. marcescens LOS. The delayed effect of interventions on S. marcescens colonization was probably due to the time it takes for new routines to have an effect, illustrated by the gradual increase in compliance with basic hygiene guidelines.
authors: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Infection Control, County Council of Östergötland, Linköping, Sweden. Electronic address: annika.samuelsson@lio.se.
authors: A
authors: A
authors: Samuelsson
authors: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Infection Control, County Council of Östergötland, Linköping, Sweden.
authors: B
authors: B
authors: Isaksson
authors: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Infectious Diseases, County Council of Östergötland, Linköping, Sweden.
authors: H
authors: H
authors: Hanberger
authors: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Paediatrics, County Council of Östergötland, Linköping, Sweden.
authors: E
authors: E
authors: Olhager
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004196:Disease Outbreaks; D011307:Drug Prescriptions / Q000592:standards; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D016868:Serratia Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D012706:Serratia marcescens / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Late-onset sepsis; Neonatal; Outbreak; Serratia marcescens