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Abstract

We report a national outbreak of complex type 755 (ct755) in Norway, with 74 cases identified between June 2021 and February 2023. Careful reviews of patient journals and interviews were performed, involving 33 hospitals throughout Norway. All available clinical isolates of collected between January 2021 and February 2023 (n = 455, including cases) from all involved hospitals were whole genome sequenced. Cases displayed a pattern of opportunistic infections, as usually observed with . No epidemiological links, common exposures or common risk factors were identified. The investigation pointed to an outbreak source present in the community. We suspect a nationally distributed product, possibly a food product, as the source. Phylogenetic analysis revealed a highly diverse bacterial population containing multiple distinct clusters. The outbreak cluster ct755 stands out as the largest and least diverse clone of a continuum, however a second cluster (ct281) also triggered a separate outbreak investigation. This report highlights challenges in the investigation of outbreaks caused by opportunistic pathogens and suggests that the presence of identical strains of in clinical samples is more common than previously recognised.

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2025-02-06
2025-02-08
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References

  1. Aracil-Gisbert S, Fernández-De-Bobadilla MD, Guerra-Pinto N, Serrano-Calleja S, Pérez-Cobas AE, Soriano C, et al. The ICU environment contributes to the endemicity of the "Serratia marcescens complex" in the hospital setting. MBio. 2024;15(5):e0305423.  https://doi.org/10.1128/mbio.03054-23  PMID: 38564701 
  2. Cho GS, Stein M, Brinks E, Rathje J, Lee W, Suh SH, et al. Serratia nevei sp. nov. and Serratia bockelmannii sp. nov., isolated from fresh produce in Germany and reclassification of Serratia marcescens subsp. sakuensis Ajithkumar et al. 2003 as a later heterotypic synonym of Serratia marcescens subsp. marcescens. Syst Appl Microbiol. 2020;43(2):126055.  https://doi.org/10.1016/j.syapm.2020.126055  PMID: 31992497 
  3. Ono T, Taniguchi I, Nakamura K, Nagano DS, Nishida R, Gotoh Y, et al. Global population structure of the Serratia marcescens complex and identification of hospital-adapted lineages in the complex. Microb Genom. 2022;8(3):8.  https://doi.org/10.1099/mgen.0.000793  PMID: 35315751 
  4. Williams DJ, Grimont PAD, Cazares A, Grimont F, Ageron E, Pettigrew KA, et al. The genus Serratia revisited by genomics. Nat Commun. 2022;13(1):5195.  https://doi.org/10.1038/s41467-022-32929-2  PMID: 36057639 
  5. Mahlen SD. Serratia infections: from military experiments to current practice. Clin Microbiol Rev. 2011;24(4):755-91.  https://doi.org/10.1128/CMR.00017-11  PMID: 21976608 
  6. Richard P, Delangle MH, Raffi F, Espaze E, Richet H. Impact of fluoroquinolone administration on the emergence of fluoroquinolone-resistant gram-negative bacilli from gastrointestinal flora. Clin Infect Dis. 2001;32(1):162-6.  https://doi.org/10.1086/317551  PMID: 11112677 
  7. Hejazi A, Aucken HM, Falkiner FR. Epidemiology and susceptibility of serratia marcescens in a large general hospital over an 8-year period. J Hosp Infect. 2000;45(1):42-6.  https://doi.org/10.1053/jhin.1999.0722  PMID: 10833342 
  8. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006;6(1):130.  https://doi.org/10.1186/1471-2334-6-130  PMID: 16914034 
  9. Friman MJ, Eklund MH, Pitkälä AH, Rajala-Schultz PJ, Rantala MHJ. Description of two Serratia marcescens associated mastitis outbreaks in Finnish dairy farms and a review of literature. Acta Vet Scand. 2019;61(1):54.  https://doi.org/10.1186/s13028-019-0488-7  PMID: 31727124 
  10. Naumiuk L, Baraniak A, Gniadkowski M, Krawczyk B, Rybak B, Sadowy E, et al. Molecular epidemiology of Serratia marcescens in two hospitals in Gdańsk, Poland, over a 5-year period. J Clin Microbiol. 2004;42(7):3108-16.  https://doi.org/10.1128/JCM.42.7.3108-3116.2004  PMID: 15243068 
  11. Blossom D, Noble-Wang J, Su J, Pur S, Chemaly R, Shams A, et al. Multistate outbreak of Serratia marcescens bloodstream infections caused by contamination of prefilled heparin and isotonic sodium chloride solution syringes. Arch Intern Med. 2009;169(18):1705-11.  https://doi.org/10.1001/archinternmed.2009.290  PMID: 19822828 
  12. Kampmeier S, Prior K, Cunningham SA, Goyal A, Harmsen D, Patel R, et al. Development and evaluation of a core genome multilocus sequencing typing (cgMLST) scheme for Serratia marcescens molecular surveillance and outbreak investigations. J Clin Microbiol. 2022;60(11):e0119622.  https://doi.org/10.1128/jcm.01196-22  PMID: 36214584 
  13. Jünemann S, Sedlazeck FJ, Prior K, Albersmeier A, John U, Kalinowski J, et al. Updating benchtop sequencing performance comparison. Nat Biotechnol. 2013;31(4):294-6.  https://doi.org/10.1038/nbt.2522  PMID: 23563421 
  14. Bolger AM, Lohse M, Usadel B. Trimmomatic: a flexible trimmer for Illumina sequence data. Bioinformatics. 2014;30(15):2114-20.  https://doi.org/10.1093/bioinformatics/btu170  PMID: 24695404 
  15. Bankevich A, Nurk S, Antipov D, Gurevich AA, Dvorkin M, Kulikov AS, et al. SPAdes: a new genome assembly algorithm and its applications to single-cell sequencing. J Comput Biol. 2012;19(5):455-77.  https://doi.org/10.1089/cmb.2012.0021  PMID: 22506599 
  16. Kolmogorov M, Yuan J, Lin Y, Pevzner PA. Assembly of long, error-prone reads using repeat graphs. Nat Biotechnol. 2019;37(5):540-6.  https://doi.org/10.1038/s41587-019-0072-8  PMID: 30936562 
  17. Gurevich A, Saveliev V, Vyahhi N, Tesler G. QUAST: quality assessment tool for genome assemblies. Bioinformatics. 2013;29(8):1072-5.  https://doi.org/10.1093/bioinformatics/btt086  PMID: 23422339 
  18. Ondov BD, Treangen TJ, Melsted P, Mallonee AB, Bergman NH, Koren S, et al. Mash: fast genome and metagenome distance estimation using MinHash. Genome Biol. 2016;17(1):132.  https://doi.org/10.1186/s13059-016-0997-x  PMID: 27323842 
  19. Parks DH, Chuvochina M, Rinke C, Mussig AJ, Chaumeil PA, Hugenholtz P. GTDB: an ongoing census of bacterial and archaeal diversity through a phylogenetically consistent, rank normalized and complete genome-based taxonomy. Nucleic Acids Res. 2022;50(D1):D785-94.  https://doi.org/10.1093/nar/gkab776  PMID: 34520557 
  20. Chaumeil P-A, Mussig AJ, Hugenholtz P, Parks DH. GTDB-Tk v2: memory friendly classification with the genome taxonomy database. Bioinformatics. 2022;38(23):5315-6.  https://doi.org/10.1093/bioinformatics/btac672  PMID: 36218463 
  21. Lees JA, Harris SR, Tonkin-Hill G, Gladstone RA, Lo SW, Weiser JN, et al. Fast and flexible bacterial genomic epidemiology with PopPUNK. Genome Res. 2019;29(2):304-16.  https://doi.org/10.1101/gr.241455.118  PMID: 30679308 
  22. Price MN, Dehal PS, Arkin AP. FastTree 2--approximately maximum-likelihood trees for large alignments. PLoS One. 2010;5(3):e9490.  https://doi.org/10.1371/journal.pone.0009490  PMID: 20224823 
  23. Argimón S, Abudahab K, Goater RJE, Fedosejev A, Bhai J, Glasner C, et al. Microreact: visualizing and sharing data for genomic epidemiology and phylogeography. Microb Genom. 2016;2(11):e000093.  https://doi.org/10.1099/mgen.0.000093  PMID: 28348833 
  24. Nguyen LT, Schmidt HA, von Haeseler A, Minh BQ. IQ-TREE: a fast and effective stochastic algorithm for estimating maximum-likelihood phylogenies. Mol Biol Evol. 2015;32(1):268-74.  https://doi.org/10.1093/molbev/msu300  PMID: 25371430 
  25. Sagulenko P, Puller V, Neher RA. TreeTime: Maximum-likelihood phylodynamic analysis. Virus Evol. 2018;4(1):vex042.  https://doi.org/10.1093/ve/vex042  PMID: 29340210 
  26. Rambaut A, Lam TT, Max Carvalho L, Pybus OG. Exploring the temporal structure of heterochronous sequences using TempEst (formerly Path-O-Gen). Virus Evol. 2016;2(1):vew007.  https://doi.org/10.1093/ve/vew007  PMID: 27774300 
  27. Ondov BD, Treangen TJ, Melsted P, Mallonee AB, Bergman NH, Koren S, et al. Mash: fast genome and metagenome distance estimation using MinHash. Genome Biol. 2016;17(1):132.  https://doi.org/10.1186/s13059-016-0997-x  PMID: 27323842 
  28. Joensen KG, Schjørring S, Gantzhorn MR, Vester CT, Nielsen HL, Engberg JH, et al. Whole genome sequencing data used for surveillance of Campylobacter infections: detection of a large continuous outbreak, Denmark, 2019. Euro Surveill. 2021;26(22):2001396.  https://doi.org/10.2807/1560-7917.ES.2021.26.22.2001396  PMID: 34085631 
  29. Ruan H, Wu Y, Zhang N, Tao Y, Wang K, Yan B, et al. Serratia marcescens causes the brown discoloration of frozen steamed stuffed buns during resteaming. J Agric Food Chem. 2024;72(9):4991-5002.  https://doi.org/10.1021/acs.jafc.3c08467  PMID: 38346801 
  30. Baráti-Deák B, Mohácsi-Farkas C, Belák Á. Searching for antagonistic activity of bacterial isolates derived from food processing environments on some food-borne pathogenic bacteria. Acta Aliment. 2020;49(4):415-23.  https://doi.org/10.1556/066.2020.49.4.7 
  31. Khayat MT, Elbaramawi SS, Nazeih SI, Safo MK, Khafagy ES, Ali MAM, et al. Diminishing the pathogenesis of the food-borne pathogen Serratia marcescens by low doses of sodium citrate. Biology (Basel). 2023;12(4):13.  https://doi.org/10.3390/biology12040504  PMID: 37106705 
  32. Amorim AMB, et al. A reddish problem: Antibiotic-resistant Serratia marcescens in dairy food commercialized in Rio de Janeiro. Int Food Res J. 2018;25:880-3.
  33. Su LH, Ou JT, Leu HS, Chiang PC, Chiu YP, Chia JH, et al. Extended epidemic of nosocomial urinary tract infections caused by Serratia marcescens. J Clin Microbiol. 2003;41(10):4726-32.  https://doi.org/10.1128/JCM.41.10.4726-4732.2003  PMID: 14532211 
A national outbreak of Serratia marcescens complex: investigation reveals genomic population structure but no source, Norway, June 2021 to February 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Arne+Michael+Taxt&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Taxt Arne Michael</a>, <a href="/search?value1=Vegard+Eldholm&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Eldholm Vegard</a>, <a href="/search?value1=Nicola+Isabelle+Kols&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kols Nicola Isabelle</a>, <a href="/search?value1=Maria+Schei+Haugan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haugan Maria Schei</a>, <a href="/search?value1=Niclas+Raffelsberger&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Raffelsberger Niclas</a>, <a href="/search?value1=Anne+Mette+Asfeldt&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Asfeldt Anne Mette</a>, <a href="/search?value1=Andr%C3%A9+Ingebretsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ingebretsen André</a>, <a href="/search?value1=Anita+Blomfeldt&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Blomfeldt Anita</a>, <a href="/search?value1=Kristin+Stenhaug+Kilhus&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kilhus Kristin Stenhaug</a>, <a href="/search?value1=Paul+Christoffer+Lindemann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lindemann Paul Christoffer</a>, <a href="/search?value1=Horst+Bentele&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bentele Horst</a>, <a href="/search?value1=Jeanette+St%C3%A5lcrantz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stålcrantz Jeanette</a>, <a href="/search?value1=Liz+Ertzeid+%C3%98deskaug&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ødeskaug Liz Ertzeid</a>, <a href="/search?value1=Thale+Cathrine+Berg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Berg Thale Cathrine</a>, <a href="/search?value1=The+Norwegian+Serratia+study+group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">The Norwegian Serratia study group</a></span>. A national outbreak of Serratia marcescens complex: investigation reveals genomic population structure but no source, Norway, June 2021 to February 2023. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(5):pii=2400291. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.5.2400291" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.5.2400291</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 10 May 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 04 Sept 2024 </span> </p>
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