Prompt control of a Serratia marcescens outbreak in a neonatal intensive care unit informed by whole-genome sequencing and comprehensive infection control intervention package

Annaleise R Howard-Jones; Catherine Janto; Zoe Jennings; James Branley; Qinning Wang; Vitali Sintchenko; Harsha Samarasekara

doi:10.1017/ash.2022.234

Prompt control of a Serratia marcescens outbreak in a neonatal intensive care unit informed by whole-genome sequencing and comprehensive infection control intervention package

Antimicrob Steward Healthc Epidemiol. 2022 Jun 27;2(1):e104. doi: 10.1017/ash.2022.234. eCollection 2022.

Authors

Annaleise R Howard-Jones^{1

2}, Catherine Janto¹, Zoe Jennings³, James Branley^{1

2

3}, Qinning Wang⁴, Vitali Sintchenko^{2

4}, Harsha Samarasekara^{1

3}

Affiliations

¹ New South Wales Health Pathology-Nepean, Penrith, New South Wales, Australia.
² Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
³ Department of Microbiology and Infectious Diseases, Nepean Hospital, Kingswood, New South Wales, Australia.
⁴ Centre for Infectious Diseases & Microbiology Laboratory Services, New South Wales Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead, New South Wales, Australia.

Abstract

Objective: This report describes a cluster of patients infected by Serratia marcescens in a metropolitan neonatal intensive care unit (NICU) and a package of infection control interventions that enabled rapid, effective termination of the outbreak.

Design: Cross-sectional analytical study using whole-genome sequencing (WGS) for phylogenetic cluster analysis and identification of virulence and resistance genes.

Setting: NICU in a metropolitan tertiary-care hospital in Sydney, Australia.

Patients: All neonates admitted to the level 2 and level 3 neonatal unit.

Interventions: Active inpatient and environmental screening for Serratia marcescens isolates with WGS analysis for identification of resistance genes as well as cluster relatedness between isolates. Planning and implementation of a targeted, multifaceted infection control intervention.

Results: The cluster of 10 neonates colonized or infected with Serratia marcescens was identified in a metropolitan NICU. Two initial cases involved devastating intracranial infections with brain abscesses, highlighting the virulence of this organism. A targeted and comprehensive infection control intervention guided by WGS findings enabled termination of this outbreak within 15 days of onset. WGS examination demonstrated phylogenetic linkage across the cluster, and genomic unrelatedness of later strains identified in the neonatal unit and elsewhere.

Conclusions: A comprehensive, multipronged, infection control package incorporating close stakeholder engagement, frequent microbiological patient screening, environmental screening, enhanced cleaning, optimization of hand hygiene and healthcare worker education was paramount to the prompt control of Serratia marcescens transmission in this neonatal outbreak. WGS was instrumental in establishing relatedness between isolates and identification of possible transmission pathways in an outbreak setting.