Continued surveillance of Serratia marcescens infections by bacteriocin typing: investigation of two outbreaks of cross-infection in an intensive care unit.

During an 8.5-month period, 198 additional isolates of Serratia marcescens were typed by bacteriocin sensitivity; 154 isolates were typable and were categorized according to our current system of 54 provisional bacteriocin sensitivity patterns. Two outbreaks of nosocomial infection due to S. marcescens occurred in our intensive care unit, involving two and five patients, respectively. The latter outbreak was caused by a strain of S. marcescens which was not sensitive to any of the 10 bacteriocins normally used. Therefore we developed a supplementary procedure based on bacteriocin production rather than bacteriocin sensitivity. Bacteriocin production was induced with mitomycin C, and the crude lysates were applied to 15 provisional bacteriocin indicator strains. The reverse typing procedure was necessary to determine the spread and ultimate subsidence of this particular outbreak of cross-infection.