Published Date: 2011-03-30 14:00:10
Subject: PRO/EDR> Serratia marcescens, contaminated solution - USA: (AL), alert
Archive Number: 20110330.0987

SERRATIA MARCESCENS, CONTAMINATED SOLUTION - USA: (ALABAMA), ALERT
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Date: Tue 29 Mar 2011
Source: The New York Times, Associated Press (AP) report [edited]
<http://www.nytimes.com/2011/03/30/us/30alabama.html>


Alabama health officials said Tue 29 Mar 2011 that 9 hospital
patients treated with intravenous feeding bags that were contaminated
have died, and the bags' maker has pulled the product. 10 more people
treated with the bags were also sickened by the bacterium _Serratia
marcescens_, the officials said. But they added that they had not
definitively tied the deaths to the bacterial outbreak at 6
hospitals.

"There is nothing to suggest the deaths were directly related to the
bacterial infection," said Dr Donald E Williamson, the state health
officer.

On 16 Mar 2011, 2 hospitals reported increased cases of _S.
marcescens_ to the Alabama Department of Public Health. Officials
linked the infection to the nutritional supplement TPN [total
parenteral nutrition], delivered by intravenous tubes. A single
pharmacy, Meds IV in Birmingham, made the bags. It has stopped
production.

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Communicated by:
ProMED-mail
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[Whether _S. marcescens_ directly caused the deaths is not clear at
this point. As can be seen in the postings listed below, ProMED-mail
has previously posted clusters of _Serratia_ infections linked to
contaminated products. TPN solutions can be used to supply adequate
nutrients chronically in individuals with a poorly functioning small
intestine or in those who required substantial removal of the small
intestine. They can also be used over a short time in hospitalized
patients with transient absorption issues.

_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. Bartolomeo 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 biologic 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. - Mod.LL]

[The state of Alabama can be located on the HealthMap/ProMED-mail
interactive map at <http://healthmap.org/r/00cn>. - Sr.Tech.Ed.MJ]

See Also

2008
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Serratia marcescens, pre-filled syringes - USA: recall 20080122.0267
Undiagnosed reactions, fatal, heparin - USA: (FL), alert, recall
20080119.0242
2007
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Serratia marcescens, heparin syringe - USA (02): (FL) 20071222.4112
Serratia marcescens, heparin syringe - USA: (IL, TX), alert
20071220.4090
Serratia marcescens, hospital, neonatal - Honduras (S. Pedro Sula)
20070316.0931
2005
----
Serratia marcescens, contaminated solution - USA (NJ): alert
20050320.0808
.................................................mpp/ll/mj/mpp
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