Serratia marcescens-contaminated baby shampoo causing an outbreak among newborns at King Abdulaziz University Hospital, Jeddah, Saudi Arabia T.A. Madani a, b, * , S. Alsaedi c , L. James b , B.S. Eldeek b , A.A. Jiman-Fatani d , M.M. Alawi b, d , D. Marwan d , M. Cudal b , M. Macapagal b , R. Bahlas b , M. Farouq c a Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia b Infection Control Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia c Department of Paediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia d Department of Microbiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia article info Article history: Received 23 November 2010 Accepted 31 December 2010 Available online xxx Keywords: Cosmetics Neonatal intensive care unit Nursery Outbreak Serratia marcescens Shampoo summary During November 2008 to January 2009, 11 babies in the neonatal intensive care (NICU) and three babies in the nursery were infected with Serratia marcescens at King Abdulaziz University Hospital in Saudi Arabia. Overall, fifteen infections were identified among 11 newborns in the NICU: septicaemia (five cases), purulent conjunctivitis (three), urinary tract infection (two), meningitis (two) and cellulitis (one). Three newborns in the nursery had three infections: purulent conjunctivitis (two cases) and omphalitis (one). Thirteen of 14 babies recovered fully but one died from S. marcescens meningitis and septicaemia. All infections were traced to intrinsically contaminated baby shampoo introduced to the units five days before the first reported case. The outbreak terminated following withdrawal of the shampoo product. Ó 2011 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. Introduction Serratia marcescens is a well-recognised cause of outbreaks of nosocomial infection, particularly in neonatal intensive care units (NICUs). 1e10 These outbreaks have been linked to a common source such as contaminated propofol, 11,12 prefilled syringes containing heparin or normal saline, 13 intravenous magnesium sulphate, 14 injection of compounded betamethasone, 15 total parenteral nutri- tion contaminated with insulin in multi-dose vials, 16 multi-dose vials of heparinised-saline, 17 extrinsic contamination of the paren- teral narcotic fentanyl by a healthcare worker (HCW), 18 and non- medicated liquid soap. 19e21 Microbial contamination of cosmetics is also well described in the literature. 22e27 Outbreaks of infections related to contamination of cosmetics have not been reported, however. In the present report, we describe an outbreak of S. mar- cescens traced to intrinsically contaminated baby shampoo used for babies in the neonatal intensive care unit (NICU) and the nursery at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Methods Institution King Abdulaziz University Hospital is an 800-bed tertiary care teaching hospital of the Faculty of Medicine at King Abdulaziz University, Jeddah, Saudi Arabia. The NICU has 26 beds and the nursery has 45 beds. The average number of monthly admissions to the NICU is 40 and to the nursery is 360, and the average daily numbers are 23 (range: 20e27), and 25 (range: 16e35) respectively. Description of the outbreak From 6 November 2008 to 9 January 2009, 14 newborns were infected with S. marcescens. The cases were identified through active surveillance for healthcare-associated infections conducted by the infection control unit. Details of the infections were collected on a standardised data collection form designed for this purpose. Data collected included demographic characteristics, primary diagnosis, site and onset of infection, specimen type and date of positive cultures, clinical and laboratory manifestations of the infection, antimicrobial susceptibility of the organism, surgical and invasive procedures performed, comorbidities, and outcome. Details of all HCWs assigned to the infected babies were also * Corresponding author. Address: Department of Internal Medicine, King Abdu- laziz University Hospital, P.O. Box 80215, Jeddah 21589, Saudi Arabia. Tel.: þ9662 6408348; fax: þ9662 6408344. E-mail address: tmadani@kau.edu.sa (T.A. Madani). Available online at www.sciencedirect.com Journal of Hospital Infection journal homepage: www.elsevierhealth.com/journals/jhin 0195-6701/$ e see front matter Ó 2011 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2010.12.017 Journal of Hospital Infection xxx (2011) 1e4 Please cite this article in press as: Madani TA, et al., Serratia marcescens-contaminated baby shampoo causing an outbreak among newborns at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, Journal of Hospital Infection (2011), doi:10.1016/j.jhin.2010.12.017