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Outbreaks of Serratia marcescens and Serratia rubidaea bacteremia in a central Kathmandu hospital following the 2015 earthquakes.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Karkey, Abhilasha 
Joshi, Niva 
Chalise, Shiva 
Joshi, Suchita 
Shrestha, Shrijana 

Abstract

BACKGROUND: Human infections with Serratia spp. are generally limited to Serratia marcescens and the Serratia liquefaciens complex. There is little data regarding the infections caused by the remaining Serratia spp., as they are seldom isolated from clinical specimens. METHODS: In this health care setting in Kathmandu, Nepal routine blood culture is performed on all febrile patients with a temperature >38°C or when there is clinical suspicion of bacteremia. During 2015 we atypically isolated and identified several Serratia spp. We extracted clinical data from these cases and performed whole genome sequencing on all isolates using a MiSeq system (Ilumina, San Diego, CA, USA). RESULTS: Between June and November 2015, we identified eight patients with suspected bacteremia that produced a positive blood culture for Serratia spp., six Serratia rubidaea and five Serratia marcescens. The S. rubidaea were isolated from three neonates and were concentrated in the neonatal intensive care unit between June and July 2015. All patients were severely ill and one patient died. Whole genome sequencing confirmed that six Nepalese S. rubidaea sequences were identical and indicative of a single-source outbreak. CONCLUSIONS: Despite extensive screening we were unable to identify the source of the outbreak, but the inferred timeline suggested that these atypical infections were associated with the aftermath of two massive earthquakes. We speculate that deficits in hygienic behavior, combined with a lack of standard infection control, in the post-earthquake emergency situation contributed to these unusual Serratia spp. outbreaks.

Description

Keywords

Cross Infection, Earthquakes, Humans, Infant, Newborn, Infant, Premature, Infection Control, Intensive Care Units, Neonatal, Microbial Sensitivity Tests, Nepal, Serratia, Serratia Infections, Serratia marcescens

Journal Title

Trans R Soc Trop Med Hyg

Conference Name

Journal ISSN

0035-9203
1878-3503

Volume Title

112

Publisher

Oxford University Press (OUP)
Sponsorship
Wellcome Trust (106158/Z/14/Z)