Serratia Outbreak From TPN in Alabama Hospitals Being Investigated

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The Alabama Department of Public Health continues an ongoing investigation of an outbreak of Serratia marcescens bacteremia in six Alabama hospitals in collaboration with the Centers for Disease Control and Prevention, the Alabama Hospital Association, the Drug Enforcement Administration, and the State Board of Pharmacy.

On March 16, ADPH was notified that an outbreak had occurred in two hospitals among patients receiving total parenteral nutrition (TPN).The CDC's initial investigation identified TPN produced by a single pharmacy, Meds IV, as a potential common source and has determined that six hospitals received TPN from this pharmacy.

Illness with Serratia marcescens bacteremia in March occurred in approximately 35 percent of patients receiving TPN from Meds IV. The affected Alabama hospitals are in the process of contacting the patients and their families who received the TPN associated with this outbreak.

At this time, ADPH is aware of 19 cases of Serratia marcescens bacteremia in these six hospitals related to this outbreak. The individuals affected are in the age range from 38 to 94 years. Eight males and 11 females were infected. The numbers of cases and deaths by hospital are as follows:

- Baptist Princeton, 7 cases, 4 deaths

- Baptist Shelby, 5 cases, 2 deaths

- Medical West, 3 cases, 1 death

- Cooper Green Mercy, 1 case, no deaths

- Baptist Medical Center Prattville, 1 case, 1 death

- Select Specialty Hospital of Birmingham, 2 cases, 1 death

The first reported case occurred in January, the second in February, and the remaining 17 cases were in March.

TPN is liquid nutrition fed through an IV using a catheter. Use of contaminated products may lead to bacterial infection of the blood.

Meds IV was notified and informed its customers of the possibility of contamination. ADPH has been informed that impacted hospitals immediately stopped using TPN received from this pharmacy and that the pharmacy discontinued all production. On March 24, Meds IV recalled all of its IV compounded products. The U.S. Food and Drug Administration (FDA) is aware of the voluntary recall.

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