title: A six-month Serratia marcescens outbreak in a Neonatal Intensive Care Unit.
abstract: OBJECTIVE
  To investigate a Serratia marcescens (S. marcescens) outbreak in a Neonatal Unit in a tertiary university hospital.
  
  
  METHODS
  Descriptive study of children admitted to the Unit with S. marcescens infection from November 2012 to March 2013. Conventional microbiological methods for clinical and environmental samples were used. The clonal relationship between all available isolates was established by molecular methods. A multidisciplinary team was formed, and preventive measures were taken.
  
  
  RESULTS
  S. marcescens was isolated from 18 children. The overall attack rate was 12%, and the case fatality rate in the Intensive Care Unit was 23.5%. The most prevalent types of infections were pneumonia (6), conjunctivitis (6), and bloodstream infection (5). Clinical isolates and environmental isolates obtained from an incubator belonged to a unique clone. The clonal relationship between all S. marcescens strains helped us to identify the possible source of the outbreak.
  
  
  CONCLUSIONS
  Isolation of S. marcescens from stored water in a container, and from the surface of an incubator after cleaning, suggests a possible environmental source as the outbreak origin, which has been perpetuated due to a failure of cleaning methods in the Unit. The strict hygiene and cleaning measures were the main factors that contributed to the end of the outbreak.
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain. Electronic address: aurea.morillo@gmail.com.
authors.forename: Áurea
authors.initials: Á
authors.lastname: Morillo
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: González
authors.affiliation: Unidad Clínica de Neonatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Josefa
authors.initials: J
authors.lastname: Aguayo
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Carreño
authors.affiliation: Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Torres
authors.affiliation: Unidad Clínica de Neonatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jarana
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Artacho
authors.affiliation: Unidad Clínica de Neonatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Jiménez
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Conde
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, Sevilla, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Aznar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008875:Middle Aged; D016868:Serratia Infections / Q000453:epidemiology*; D012706:Serratia marcescens; D013997:Time Factors
keywords: Brote epidémico; Disease outbreak; Healthcare-associated infection; Infección asociada a la asistencia sanitaria; Infección nosocomial; Intensive Care Units; Neonatal; Neonatales; Nosocomial Infection; Serratia marcescens; Unidades de Cuidados Intensivos