Two premature babies die after outbreak of deadly bug in neonatal unit

Published: 28-Sep-2012

Infection prevention measures stepped up following deaths at University Hospital of North Staffordshire

Infection control measures at the University Hospital of North Staffordshire have been stepped up following the deaths of two premature babies from the Serratia marcescens infection.

The infants died in the neonatal intensive care unit (NICU) in July, but details of the incidents were only made public this week. Four other youngsters at the facility were also found to be carrying the potentially-deadly bug, but later recovered.

Since the outbreak, the hospital has carried out an extensive deep clean and has reviewed its infection prevention practices in conjunction with the Health Protection Agency (HPA). It also carries out weekly screening of patients and says there have been no new cases.

Serratia marcescens is an organism that lives naturally in the gut. In healthy people, this causes no problems, but where people may be more vulnerable, the organism can cause urinary tract, wound and bloodstream infections and can potentially be life threatening.

The hospital is also likely to review its decontamination services as the bug can be transmitted person to person or via equipment. It can also be passed from mother to baby during childbirth.

Julia Bridgewater, chief executive of the University Hospital of North Staffordshire NHS Trust, said: "The trust identified an infection in our NICU in July, Serratia marcescens, which can affect babies born extremely premature.

"Sadly, two babies who died, both born before 28 weeks, had this uncommon infection and post-mortems confirmed Serratia marcescens as the cause of death.

"The trust would like to offer its sincere condolences to those families who have lost a baby."

It is quite a difficult adversary, but at the end of day it can be kept at bay by ordinary straightforward measures like cleaning

The trust has also told parents of babies recently discharged from the unit that there is ‘no need to worry’.

And Bridgewater said they had not made details of the deaths public at the time as one youngster was still in isolation being treated for the bug.

The outbreak follows similar scares at other hospitals in the UK. In May this year seven patients were infected at Belfast’s Royal Victoria Hospital. None of those died. But five years ago an infant died from the same infection at Birmingham Heartlands Hospital.

Hugh Pennington, a professor of bacteriology at the University of Aberdeen, said the bug was particularly good at thriving once it got into a hospital environment. He added: “It is unusual because hospitals are very good at keeping them {the bugs} at bay.

“It is a very common environmental bug. Some people carry it well without falling ill and it can grow in things like, basically, ordinary water.

“If it gets established in a hospital, and of course if the patients themselves are very vulnerable, which these very, very tiny babies are because their immune systems aren’t developed, you can get trouble.”

“It has a track record of causing problems hospitals. It may well have been something to do with cleaning, although I don’t know the particular circumstances of these cases. It is the sort of bug you can keep at bay by using preventive measures including really good cleaning and making sure it doesn’t set up residence. Sometimes the bug does and someone gets infected and it spreads from them, gets into the environment, and before you know it you have more cases and then have to have a deep clean.

“It is quite a difficult adversary, but at the end of day it can be kept at bay by ordinary straightforward measures like cleaning.”

Serratia marcescens is the most common strain of the Serratia bacteria. HPA figures, taken from voluntary reporting by trusts in England, Wales and Northern Ireland, show a general decline in incidents of Serratia in hospitals, from around 1,270 in 2006 to 943 in 2010. However, of those reports, 82% in 2010 were found to be the Serratia marcescens strain. The second most common is Serratia liquefaciens. The papers also show the infection is more likely to affect those under the age of one year or over the age of 64, and is more often discovered in males, particularly in the older age group.

A report from December 2011 highlights Wales, Northern Ireland and the North East of England as being hotspots for the infection, having a higher incidence rate per head of population than in other areas of the UK.

The infection is treated with antibiotics such as carbapenems and cephalosporins, depending on the susceptibility of the organism to antibiotics and the site of the infection. However, there is concern over the growing resistance of the bacteria to a number of antibiotics including cephalosporins and fluoroquinolones.

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