Auditing Serratia marcescens cases to reduce antimicrobial use

Hi there, I’m Laura and I’m one of the small animal sector partners at Bishopton and we have just become highly commended runner up for antimicrobial stewardship. So here at Bishopton, we are a large general practice with a referral caseload and it’s really important to us as part of our clinical governance and kind of patient care, we monitor all of our microbial swabs.

So what are the bacterias and kind of bugs that we’ve got in the hospital? Are there any patterns with regards to surgeon, operation done, kits, site? So as part of kind monitoring for our surgical team, we noticed a bit of an increase in Serratia marcescens in 2024. So after a little bit of research, we highlighted it was a nosocomical bacterium and often adhered to plastics and is resistant to quaternary disinfectants, which we kind of had found there, kind of culture and sensitivity profile was pretty scary. And it was just a book that we never really heard of before and kind of had a flurry of cases. So we’re all a little bit worried, worried about resistance. It seemed to be particularly resistant to fluoroquinolones.

And it just led to us kind of doing a bit of a deep dive into which animals were affected. Was it all of our surgical patients? Were the orthopedic patients at higher risk? Was it linked to a specific kit? So was it a specific 2,7 fracture kit, kind of plating kit or our MMP kit?

And was it linked to the use of enzymatic cleaners? Were we seeing it more in our lap kit that we kind of put through the ampoule with case kind of one in the day and then it goes through kind of a wet and cold sterilant and came was there a link there. So we because we I suppose as well kind of basic things that we could do in the hospital we knew that it was adhered to the plastic and there’s a human paper in America where it’s linked to sinks and soap dispensers so we kind of went on a soap dispenser swab and did lots of environmental swabs and kind of managed it down to one kind of within the nozzle.

So we kind of looked at our protocol of what we did with these nozzles, how often were they cleaned. So we kind of created a protocol where all of the soap dispenser and patient prep and kind of surgical scrub area, their nozzles were cleaned once a week with bleach and that would be rotated through all of our sites and really came down hot on kind of acrylic nails and any kind of unnecessary plastic.

We looked at kind of our hospital environment and looked at our bedding and made sure our disinfection protocols were being followed and the nurses were allowing enough contact time. And we ensured that all wounds were completely covered until they left the hospital again just to minimize kind of the transmission between patients. We kind of really saw a dip in cases, which was great. And then a little bit more of a kind of a flurry.

So we went to IDEX, our laboratory and kind of asked them to map the kind of family of bacteria to see if they were all linked. And again, you know, is this a hospital bug or is this just an increase in serratia in the environment? So IDEX were absolutely brilliant and kind of mapped them all. So all of the serratia cases were different.

which gave us the reassurance that our protocols were good. And we’ve continued to monitor our cases monthly and with kind of our new protocols, really just being aware of what’s going on and really focusing on contact time and kind of swapping all of the swabs and making sure that we add bleach into our disinfection protocol. We’ve seen a huge reduction in the serratia, ultimately impacting patient care and reducing our antibiotic use.

And we’ve also, again, if we do see positive cases, we don’t actually treat them, even though we do culture them, we don’t actually treat them with oral antibiotics. We’ve started using Peptivap foam. So again, with huge, huge results. So again, just, you know, these guys would have been prescribed a broad spectrum of antibiotics, which is amoxicillin, clavulanic acid, and actually that those cases no longer get antibiotics, which has reduced our cases. So it actually equated to 31 cases in a 10 month period, which is brilliant.