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Nosocomial outbreak caused by disinfectant-resistant Serratia marcescens in an adult intensive care unit, Hungary, February to March 2022
- Adrienn Hanczvikkel1,2 , Ákos Tóth1 , Irén Anna Kopcsóné Németh3 , Orsolya Bazsó3 , Lőrinc Závorszky3 , Lilla Buzgó1 , Virág Lesinszki1 , Dániel Göbhardter1 , Erika Ungvári1 , Ivelina Damjanova1 , Attila Erőss3 , Ágnes Hajdu1
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View Affiliations Hide AffiliationsAffiliations: 1 National Center for Public Health and Pharmacy (NNGYK), Budapest, Hungary 2 ECDC Fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden 3 North-Pest Central Hospital – Military Hospital (ÉPC-HK), Budapest, HungaryAdrienn Hanczvikkelhanczvikkel.adrienn nngyk.gov.hu
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Citation style for this article: Hanczvikkel Adrienn, Tóth Ákos, Kopcsóné Németh Irén Anna , Bazsó Orsolya, Závorszky Lőrinc, Buzgó Lilla, Lesinszki Virág, Göbhardter Dániel, Ungvári Erika, Damjanova Ivelina, Erőss Attila, Hajdu Ágnes. Nosocomial outbreak caused by disinfectant-resistant Serratia marcescens in an adult intensive care unit, Hungary, February to March 2022. Euro Surveill. 2024;29(26):pii=2300492. https://doi.org/10.2807/1560-7917.ES.2024.29.26.2300492 Received: 12 Sept 2023; Accepted: 01 Mar 2024
Abstract
In 2022, an outbreak with severe bloodstream infections caused by Serratia marcescens occurred in an adult intensive care unit (ICU) in Hungary. Eight cases, five of whom died, were detected. Initial control measures could not stop the outbreak. We conducted a matched case–control study. In univariable analysis, the cases were more likely to be located around one sink in the ICU and had more medical procedures and medications than the controls, however, the multivariable analysis was not conclusive. Isolates from blood cultures of the cases and the ICU environment were closely related by whole genome sequencing and resistant or tolerant against the quaternary ammonium compound surface disinfectant used in the ICU. Thus, S. marcescens was able to survive in the environment despite regular cleaning and disinfection. The hospital replaced the disinfectant with another one, tightened the cleaning protocol and strengthened hand hygiene compliance among the healthcare workers. Together, these control measures have proved effective to prevent new cases. Our results highlight the importance of multidisciplinary outbreak investigations, including environmental sampling, molecular typing and testing for disinfectant resistance.
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