Published Date: 2007-03-16 18:00:02
Subject: PRO/EDR> Serratia marcescens, hospital, neonatal - Honduras (S.Pedro Sula)
Archive Number: 20070316.0931
SERRATIA MARCESCENS, HOSPITAL, NEONATAL - HONDURAS (SAN PEDRO SULA)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Tue 13 Mar 2007
From: Brent Barrett <firstname.lastname@example.org>
Source: SperoForum [edited]
& El Heraldo, Honduras [in Spanish]
In Sao Pedro Sula, 2nd city of Honduras, officials at the Mario Rivas
hospital have shut down the neonatology ward after the deaths of 10
newborns over the 10-11 Mar 2007 weekend. The bacteria responsible,
antibiotic resistant _Serratia marcescens_, had been identified
earlier in the hospital but it took the deaths of the infants --
among them were a set of triplets and a set of quintuplets -- to
prompt the shutdown.
Samuel Santos, neonatologist and acting director of the hospital,
confirmed the deaths of al least 11 newborns as a result of serratia
infection in the period between 16 Jan 2007 and last weekend (10-11
Mar 2007), and added that another 6 deaths are being investigated.
Santos indicated that there have been 21 deaths in February and March
 but explained that it cannot be said that all were a
consequence of serratia infection, given that some babies were
premature or of very low birth-weight.
According to a hospital spokesperson, an antibiotic resistant strain
of _Serratia marcescens_ had been noted over the course of the last 2
years. Cultures taken from hospital water systems, personnel, and
facilities have shown the organism. Other bacteria, such as
_Klebsiella_ & _Pseudomonas_ , which cause hospital infections,2 were
A team of epidemiologists and other experts from the Public Health
Ministry of Honduras are investigating the outbreak. They have begun
inspecting the hospital, especially the emergency room and
neonatology ward and taking samples. Since the weekend, no other
babies have died as a result of _Serratia marcescens_ infection. The
Public Health Ministry has alerted other hospitals in the country.
Public complaints have been reported over the treatment of children
at the hospital. Medical students are frequently the actual
caregivers to patients, and children are frequently mixed in with
adults in the wards.
Honduras is the 2nd poorest country in the Americas, and has one of
the highest rates of unemployment and illiteracy. Honduras' infant
mortality rate is 25.82 deaths per 1000 live births. By comparison,
the USA has 6.43 deaths per 1000 live births, while the UK has 5.08
deaths per 1000 live births.
[Byline: Martin Barillas]
[This is an impressive cluster based on 10 deaths over 2 days. More
information is needed to clarify the epidemiology and what the
denominator of infection was in the infants. Additionally, it is not
at all clear if the deaths occurred before or after discharge.
_Serratia marcescens_, as well as other bacilli, can contaminate
solutions used in health care [see ProMED ref. below], and such a
contamination could be the source here rather than infant-to-infant
or health care worker-to-infant spread.
_Serratia marcescens_ can cause a wide variety of hospital-acquired
infections and has been associated with infections in injecting drug
users, particularly endocarditis and osteomyelitis. Immunologically
normal individuals can acquire _S. marcescens_ infection especially
in the hospital setting. The organism is widespread in the
environment but not a common component of the human fecal flora.
Environmental and even some clinical strains of _S. marcescens_ can
produce a red pigment called prodigiosin. Bartolemeo Bizio first
described the organism in 1819 as the cause of red discoloration of
polenta (a dish made from corn meal), which discredited the claim
that the color was due to the miraculous appearance of blood. He gave
the organism its genus name to honor Serafino Serrati, whom he felt
had not received proper credit for invention of the steamboat, and
its species name for the Latin word for "to decay," because of the
tendency of the pigment to change color as the colonies age. Serial
passage may also cause the organism to lose its pigment producing ability.
The production of the pigment together with the belief that the
bacterium was nonpathogenic, led to its use as a biological marker to
study, among other things, transmission of bacteria through speech
and contact, ascending colonization of the bladder in patients with
urinary catheters, and the dissemination of aerosolized bacteria
after experimental release in models of biologic warfare.
A map of Honduras showing San Pedro Sula in the department of Cortes
can be found at:
<http://www.un.org/Depts/Cartographic/map/profile/honduras.pdf>. - Mod. LL]