Serratia marcescens bacteraemia outbreak in haemodialysis patients with tunnelled catheters due to colonisation of antiseptic solution. Experience at 4 hospitals.
BACKGROUND
The application of antiseptic solution for handling tunnelled catheters is recommended in patients undergoing haemodialysis. These routine antiseptic procedures in handling catheters are crucial to avoid complications. We report an outbreak of Serratia marcescens (S. marcescens) bacteraemia in numerous haemodialysis units of the Community of Madrid.


METHODS
The first cases of bacteraemia due to S. marcescens were isolated in December 2014. The Preventive Medicine Services were informed of the detection of an atypical pathogen in several patients, suspecting a probable nosocomial outbreak. Information from 4 centres with similar S. marcescens bacteraemia was analysed.


RESULTS
Twenty-one cases of bacteraemia related to S. marcescens were identified. The mean age of affected patients was 72±10 years. The mean time on haemodialysis of affected patients was 33±13 months (range: 3-83 months), the median time of tunnelled catheter was 22±13 months. In 11 cases the clinical picture was similar, with hypotension and general malaise during the haemodialysis session. Fever was present in a further 7 cases. In 3 cases the presentation was asymptomatic and was detected by blood cultures. All patients had tunnelled catheters (12 patients with catheter in the right jugular vein, 5 in the left jugular, 2 in the right femoral artery and 2 in the left subclavian artery). Gentamicin intravenous doses (1mg/kg) with catheter lock solution with ciprofloxacin post-dialysis were administered for 3 weeks in 6 patients. In 12 patients the treatment was ceftazidime (2g IV) plus catheter lock solution with the same antibiotic, for 2 weeks. Four patients received oral ciprofloxacin for 2 weeks, in one case together with IV vancomycin. The patients were asymptomatic and without new episodes 48hours after the treatment. No major complications were observed. The teams informed the health authorities of the situation, which then reported the presence of batches of antiseptic (chlorhexidine 0.05 and 2%) colonised by S. marcescens. Given the routine application of this antiseptic in handling catheters at these units, this was considered the source of contagion and new cases were not observed after the removal of the batches.


CONCLUSIONS
The presence of bacteraemia due to unconventional germs should alert us to a potential outbreak. The application of a solution contaminated by S. marcescens in haemodialysis catheters was the source of bacteraemia. The intravenous antibiotic treatment and the catheter lock solution allowed an excellent survival of patients and catheters.
Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España. Electronic address: jluis.merino@salud.madrid.org.
José L
JL
Merino
Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España.
Hanane
H
Bouarich
Sección de Medicina Preventiva, Hospital Universitario del Henares, Coslada (Madrid), España.
Mª José
MJ
Pita
Servicio de Nefrología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España.
Patricia
P
Martínez
Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España.
Blanca
B
Bueno
Sección de Nefrología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes (Madrid), España.
Silvia
S
Caldés
Sección de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España.
Elena
E
Corchete
Servicio de Nefrología, Complejo Hospitalario de Jaén, Jaén, España.
Mª Teresa
MT
Jaldo
Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España.
Beatriz
B
Espejo
Sección de Nefrología, Hospital Universitario del Henares, Coslada (Madrid), España.
Vicente
V
Paraíso
D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local; D016470:Bacteremia / Q000175:diagnosis*; D002408:Catheters, Indwelling / Q000382:microbiology*; D003428:Cross Infection / Q000175:diagnosis*; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012706:Serratia marcescens / Q000302:isolation & purification*
D000891:Anti-Infective Agents, Local
Bacteraemia; Bacteriemia; Catheters; Catéteres; Hemodialysis; Hemodiálisis; Serratia