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The article reports an outbreak of Serratia marcescens blood stream infection (BSI) in the pediatric ward at the Chung-Ang University Hospital in Seoul, Korea associated with a contaminated multidose dropper bottle used for nebulization. Hospital investigation revealed poor hand hygiene and possible contamination of the common drug bottles used for nebulization. According to speculation, the absence of mortality was due to the immediate initiation of effective antibiotic therapy, absence of risk factors or history of ventilator care or airway suction.