Investigation of an outbreak of Serratia marcescens in a neonatal unit via a case-control study and molecular typing
Investigation of an outbreak of Serratia marcescens in a neonatal unit via a case-control study and molecular typing
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DOI：
10.1016/j.ajic.2006.12.012
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发表时间：
2008-02-01
影响因子：
4.9
通讯作者：
Korman, Tony M.
中科院分区：
文献类型：
--
作者：
Friedman, N. Deborah;Kotsanas, Despina;Korman, Tony M.
背景：2004年3月，粘质沙雷氏菌感染或定植影响了新生儿服务单位（NBS）所有新生儿的三分之一。方法:我们进行了病例对照研究和自动核糖分型。结果：49例与64例对照。NBS的总体平均住院时间（LOS）为67天，对照组为36天，P = 0.005。病例平均出生体重低于对照组（分别为1566 g和1968 g， P = 0.02）。对黏液形成有显著意义的危险因素包括：胎膜早破（优势比[OR]， 2.7； 95%可信区间[95% CI]: 1.0-7.1 P = 0.05）、在我院阴道分娩（OR, 2.1; 95% CI: 0.9-4.6; P = 0.06）、分娩时插管（OR, 2.3 95% CI: 0.9-5.2; P = 0.05）、机械通气（OR, 2.1: 95% CI: 0.9-4.4; P = 0.06）和茶碱治疗（OR, 2.5; 95% CI: 1.1-5.4 P = 0.02）。多元logistic回归分析显示，在我院阴道分娩（OR, 3.4; 95% CI: 1.4-8.2; P = 0.007）和产后30天（OR, 4.4; 95% CI: 1.8-10.6; P = 0.001）是获得粘质肉瘤的独立危险因素。核糖分型显示5种限制性内切型。结论：新生儿出生体重低于对照组，在我院经阴道分娩出生，新生儿住院时间较长，对呼吸支持的需求较大。标本的核糖分型显示，这次暴发不是克隆性的。
Background: In March 2004, infection or colonization with Serratia marcescens affected one third of all neonates in a newborn services unit (NBS).Methods: We performed a case-control study and automated ribotyping.Results: Forty-nine cases were compared with 64 controls. The overall mean length of stay (LOS) in the NBS was 67 days for cases and 36 days for controls, P =.005. Cases were of lower mean birth weight than controls (1566 g vs 1968 g, respectively, P =.02). Risk factors that trended toward significance for S marcescens acquisition included the following: premature rupture of membranes (odds ratio [OR], 2.7; 95 % confidence interval [95 % CI]: 1.0-7.1 P =.05), vaginal delivery at our hospital (OR, 2.1; 95 % CI: 0.9-4.6; P =.06), intubation at delivery (OR, 2.3 95% CI: 0.9-5.2; P =.05), mechanical ventilation (OR, 2.1: 95% CI: 0.9-4.4; P =.06), and theophylline treatment (OR, 2.5; 95% CI: 1.1-5.4 P = .02). Multiple logistic regression analysis revealed vaginal delivery at our hospital (OR, 3.4; 95% CI: 1.4-8.2; P =.007) and LOS > 30 days (OR, 4.4; 95% CI: 1.8-10.6; P =.001) as independent risk factors for S marcescens acquisition. Ribotyping of specimens revealed 5 restriction patterns.Conclusion: Cases were of lower birth weight than controls, were born by vaginal delivery at our hospital, had longer LOS in NBS, and had greater requirements for respiratory support. Ribotyping of specimens revealed that this outbreak was not clonal.