A nosocomial outbreak of sepsis caused by Serratia marcescens, July 1999 - Tokyo
(IASR 2000; 21:166-167)

In the end of July 1999, 12 in-patients, admitted in the third floor of S General Hospital in Tokyo, presented sudden onset of high fever, coagulation disorders (disseminated intravascular coagulation), and acute renal failure, and 5 died. Legionellosis was initially suspected. On July 30, the local health center carried out environmental samplings including the cooling tower systems.

On August 3, the Tokyo Metropolitan Government developed the investigation team to determine the cause and routes of transmission. Legionella and Serratia marcescens were positive from the environmental sampling, while the 10 in-patients were only S.marcescens positive. Table 1 shows clinical courses of those in-patients. Serratia infection was strongly suspected as the cause of sepsis. Those cases were defined as "in-patient who developed fever 38C or more during July 26 to 29 and S. marcescens was isolated by blood culture". Twelve strains were isolated from the blood. In order to compare molecular and biochemical characteristics of S.marcescens in the S Hospital, sputum and urine cultures were attempted from other in-patients and staff. Results were summarized in Table 2.

Those isolates were classified in 9 groups by 31 characterization tests, and 12 isolates from the 10 sepsis cases were all in the same group. However, the route of transmission remained unknown by field investigation.

Further details are published in "Report of the disease investigation team for unknown cause, Tokyo Metropolitan Government, March 2000" in Japanese.

Reported by: Miyoko Endoh, Rumi Okuno, Yukako Shimojima, Iwao Murata, Hiromasa Sekine, and Yataro Kokubo, Tokyo Metropolitan Research Laboratory of Public Health.

Correspondence: Fax: +81-3-3368-4060

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