Serratia marcescens bacteremia after carotid endarterectomy and coronary artery bypass grafting.

Serratia Marcescens is a common, water-borne hospital colonizer. Respiratory secretions, wounds, and urine are frequently recognized areas of Serratia colonization. Serratia bacteremias usually occur nosocomially and are associated with high mortality and morbidity rates. Serratia bacteremias may be primary or secondary from an identifiable source. Hospital-acquired S marcescens bacteremias have no known source in half of the cases. We present a case of nosocomial primary S marcescens bacteremia in a surgical patient successfully treated with levofloxacin.     

An outbreak of Serratia marcescens in 14 adult cardiac surgical patients associated with 12-lead electrocardiogram bulbs.

Two clusters of Serratia marcescens in 14 adult cardiac surgical patients occurred over 10 months in an 876-bed teaching hospital. The 14 infections that were studied were as follows: one sternal and five leg incisions, five pneumonias, one bacteremia, one urinary tract infection, and one infected internal defibrillator site. The first cluster included four pneumonias, one urinary tract infection, and one bacteremia. Corrective actions were taken based on outbreak data through no source was identified. No further infections occurred during the following 2 months. The second cluster included one sternal and five leg incisions, an infected internal defibrillator incision site, and one pneumonia. Serratia marcescens was isolated from six electrocardiogram rubber welsh bulbs with sensitivities identical to patient isolates that indicated a common source outbreak in at least the second cluster of infections. Disposable electrocardiogram leads were introduced and the problem was resolved. We conclude that reusable electrocardiogram welsh bulbs are a vector for postoperative infections.     

Serratia marcescens bacteremia because of contaminated prefilled heparin and saline syringes: a multi-state report

A national outbreak of Serratia marcescens bacteremia because of contaminated prefilled heparin and saline syringes led to their recall. We evaluated the clinical impact of this outbreak in 57 patients at 3 centers. All patients were symptomatic and were treated with intravenous antibiotics with a fatal outcome in 1 patient.     

Clinical experiences of the infections caused by extended-spectrum beta-lactamase-producing Serratia marcescens at a medical center in Taiwan

CTX-M-3 has become the most common extended-spectrum beta-lactamase (ESBL) produced by Serratia marcescens in Taiwan. An expanded effort to detect ESBL among 123 nonrepetitive isolates of S. marcescens was made and 15 (12%) ESBL-producers were identified, all revealing CTX-M-3. Without routinely detecting the ESBL for S. marcescens in clinical laboratories, 80% of the ESBL-producers were reported to be susceptible to cefepime. The clinical spectrum of ESBL-producing S. marcescens-related infections included febrile urinary tract infection (n = 3); afebrile pyuria (n = 2); pneumonia (n = 3); spontaneous bacterial peritonitis (n = 3); secondary bacteremia (n = 2) and one each with primary bacteremia and colonization of the central catheter tip. Overall, the 30-day mortality rate was 33.3% (5/15) and the outcome depended on the severity of the underlying disorder and infection per se. In conclusion, although our case numbers were limited, due to the substantial incidence and associated mortality of ESBL-producing S. marcescens and its potential treatment failure by an apparently susceptible cephalosporin, we recommend that the detection and report of ESBL production for S. marcescens in clinical laboratories be made mandatory.     

1株粘质沙雷氏菌噬菌体的分离和鉴定

目的 以粘质沙雷氏菌为宿主菌,从河水中分离噬菌体,在体外和蚊虫肠道验证其裂解能力。方法 以粘质沙雷氏菌为宿主菌,在深圳周边河水中分离噬菌体,通过单、双层平板筛选单一的烈性噬菌体;利用噬斑形成实验验证噬菌体的裂解谱;通过饲喂实验验证噬菌体在埃及伊蚊肠道内的裂解作用。结果 从深圳河流污水中成功分离得到一株针对粘质沙雷氏菌的烈性噬菌体SHENZHEN01, 该噬菌体噬斑直径1 mm左右(培养10 h), 边界清楚;对粘质沙雷氏菌Sm01、Baz01具有明显的裂解能力,对其他粘质沙雷氏菌菌株、大肠杆菌、金黄色葡萄球菌、绿脓杆菌无裂解作用;对饲喂埃及伊蚊的粘质沙雷氏菌Sm01仍保持明显的裂解能力。结论 该噬菌体裂解作用具有特异性,而且在蚊虫肠道内仍能保持活性,具有可以用来治疗粘质沙雷氏菌引起的相关疾病的潜在价值。     

An outbreak of Serratia marcescens associated with the anesthetic agent propofol

BACKGROUND: In October 1999, 7 patients with postoperative infections caused by Serratia marcescens were identified at a community hospital in Ontario, Canada. We describe the investigation of this outbreak. METHODS: We undertook a case-control study to determine risk factors associated with infection. Case subjects consisted of patients who had undergone surgery and acquired bacteremia or wound infections that, when cultured, grew S marcescens. Control subjects were selected from the cohort of patients who underwent surgery at the same hospital during the outbreak period. Chart reviews were conducted for case and control subjects. Environmental samples were taken from medications and liquids in the operating rooms and from one health care professional who was involved in all the cases. S marcescens isolates were forwarded to a reference laboratory for pulsed field gel electrophoresis. RESULTS: We identified 7 case subjects and 29 control subjects. Five patients had bacteremia and 2 patients had wound infections. Two patients with bacteremia died. All patients with bacteremia or wound infections were exposed to a single anesthetist (anesthetist A) and were administered the anesthetic medication propofol. These patients were more than 40 times more likely to have had anesthetist A administer their anesthetic (OR 41.6, 95% CI 3.6-1120) and 22 times more likely to have received propofol (OR 22, 95% CI 2.1-550) than were control subjects. None of the environmental samples or cultures from anesthetist A were positive for S marcescens. Six of the 7 human isolates had an identical pulsed field gel electrophoresis pattern, and the seventh was untypable. CONCLUSIONS: This outbreak of postoperative infections was very strongly linked to the use of propofol by one anesthetist. Health care professionals must follow strict aseptic techniques when using propofol and should review these techniques regularly.     

Patient factors contributing to the emergence of gentamicin-resistant Serratia marcescens.

One hundred forty nosocomial Serratia marcescens infections (including 76 cases of bacteremia) were identified by prospective surveillance from 1975 through 1977 and retrospective chart review from 1968 through 1974. Thirty-four cases (24 per cent) involved gentamicin-resistant strains. All gentamicin-resistant strains appeared after 1974. Ninety per cent of the patients had undergone surgery, and 88 per cent had received prior antimicrobial therapy. The emergence of gentamicin-resistant S. marcescens paralleled the increase in usage of gentamicin. Prior use of gentamicin for more than two days in an individual patient was a significant risk factor (P = 0.0002) for being infected with a Serratia that was gentamicin-resistant. Other factors which separated gentamicin-resistant Serratia infections from gentamicin-sensitive Serratia infections were (1) urinary site of infection (P = 0.0005), (2) urinary catheter (P = 0.002), (3) endotracheal tube or tracheotomy (P = 0.03) and (4) increasing duration of hospitalization (P less than 0.05). Thirty-three of 34 (97 per cent) patients with gentamicin-resistant strains had urinary catheters. Specific measures to control infection were effective in decreasing the incidence of infections caused by gentamicin-resistant Serratia.     

Acute epiglottitis due to Serratia marcescens in an immunocompetent adult

Acute epiglottitis (AE) is inflammation of the epiglottis and contiguous tissues, which carries a potential for complete airway obstruction. With routine pediatric immunization for Hemophilus influenzae serotype b, epiglottitis is now more prevalent in adults, with a shift in the causative organisms and a change in the natural history of this disease. Over the past 5 decades, Serratia marcescens has gone from being recognized as a harmless saprophyte to an important opportunistic human pathogen. It is known to be associated with outbreaks of nosocomial infections, but it is an uncommon cause of serious invasive infections in patients presenting from the community. The authors present a fatal case of AE caused by S marcescens in a previously immunocompetent 58-year-old woman, which was complicated by fasciitis, myositis and bacteremia. To the authors' knowledge, till date, only 3 cases of AE by S marcescens have been reported, all in immunocompromised patients.     

Detection of gram-negative bacteremia by limulus amebocyte lysate assay: evaluation in a rat model of peritonitis

A spectrophotometric Limulus amebocyte lysate assay using lysis filtration and centrifugation has been developed for the detection of gram-negative bacteria in blood. The assay is directed at detection of endotoxin in viable and nonviable bacteria present in the blood-stream and not detection of free endotoxin in plasma. The assay was evaluated in a model of peritonitis in which rats were challenged with an inoculum consisting of sterilized human feces, barium sulfate, and one of eight species of bacteria. This assay was able to detect gram-negative bacteremia due to Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens, Proteus mirabilis, and Klebsiella pneumoniae in the rat model when compared with sham-inoculated uninfected rats. The assay failed to detect bacteremia due to Bacteroides fragilis or Staphylococcus aureus, nor was there a significant rise in absorbance when a pellet containing sterilized feces was implanted in the rat.     

Serratia marcescens osteomyelitis of the clavicle and sternoclavicular arthritis complicating infected indwelling subclavian vein catheter

Serratia marcescens bacteremia, osteomyelitis of the right clavicle, and septic arthritis of the right sternoclavicular joint developed in a 69-year-old woman after a right subclavian vein catheter was in place for five days. The infections were cured with the combination of gentamicin and ceftizoxime. There have been three previously reported cases of osteomyelitis of the clavicle following indwelling subclavian vein catheterization; two were caused by Staphylococcus aureus and one by Pseudomonas aeruginosa.     

Nosocomial bacteremia in a large Spanish teaching hospital: analysis of factors influencing prognosis

Five hundred forty-three episodes of nosocomial bacteremia were prospectively followed in a large Spanish university hospital. The commonest isolates were Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida species. The most frequent sources of infection were intravenous lines, urinary tract, and lower respiratory tract. Overall mortality was 18%. A step-forward logistic regression analysis defined eight variables independently influencing the outcome: shock, underlying rapidly fatal disease, high-risk source of bacteremia (intraabdominal, lower respiratory tract, or not identified), age more than 70 years, hospitalization in intensive care or medical units, inappropriate antibiotic treatment, infection due to a high-risk microorganism (P. aeruginosa, Serratia marcescens, Klebsiella, Bacteroides, or Candida), and development of septic metastasis. The identification of those factors independently influencing the outcome and their possible modification may represent a further step in the control of nosocomial bacteremia by improving its prognosis.     

Effect of aerosol immunization with RE 595 Salmonella minnesota on lung bactericidal activity against Serratia marcescens, Enterobacter cloacae, and Pseudomonas aeruginosa.

Intrapulmonary bactericidal activity was measured after mice were given 3 weekly aerosol exposures to acid-hydrolyzed Re 595 Salmonella minnesota. Ten days after their last immunization, mice were challenged with aerolized Serratia marcescens, Enterobacter cloacae, or Pseudomonas aeruginosa. Quantitative bacterial counts in ground lung were obtained immediately after exposure and again 4 hours later. Enhanced bactericidal activity against Serratia marcescens and Enterobacter cloacae was seen in immunized animals, whereas no difference with Pseudomonas aeruginosa was noted. In separate studies, immunization with Serratia marcescens yielded a similar enhancement of lung bactericidal activity. Mucociliary transport, as measured by disappearance of aerosolized Serratia marcescens labeled with phosphorus-32, was identical for both immunized and control animals. Using a standardized in vitro mouse alveolar macrophage phagocytic system, lung washes from animals immunized with Re 595 Salmonella minnesota had significant opsonic activity for Serratia marcescens but not for Pseudomonas aeruginosa.     

Microbial contamination of enteral feeding solution and its prevention.

In an investigation of microbial contamination of enteral feeding solutions, all 22 residual solutions obtained immediately after administration were contaminated at concentrations of 10(3) to 10(6) viable counts/ml. Major contaminants were glucose-nonfermenting gram-negative bacilli such as Pseudomonas aeruginosa and Acinetobacter calcoaceticus var anitratus. Contamination seemed to have been caused by frequent reuse of bag-type containers and the infusion tubes connected to the bags, neither of which can be washed or dried. Decontamination methods were evaluated by using polypropylene containers that can be washed and disinfected for administration. Few Serratia marcescens on the inside wall of the container were removed by rinsing with tap water, alone or in combination with detergent scrub. Tap water and detergent plus air-drying at 56 degrees C for 1 hour reduced Serratia marcescens only somewhat. Tap water and detergent plus immersion in 0.01% sodium hypochlorite for 1 hour or in water at 70 degrees C for 3 minutes eliminated all 10(11) cells of Serratia marcescens.     

Influence of relative humidity on particle size and UV sensitivity of Serratia marcescens and Mycobacterium bovis BCG aerosols.

SETTING: A study of Serratia marcescens and BCG aerosols. OBJECTIVE: To evaluate the effect of relative humidity (RH) on (1) the particle size and (2) sensitivity of 254nm germicidal ultraviolet (UV) irradiation. METHODS: We built a RH controlled experimental chamber into which bacteria were aerosolized, exposed to varying amounts of UV irradiance over measured time periods, and quantitatively evaluated for viability. Aerosolized Serratia marcescens and bacille Calmette-Guérin (BCG) were subject to UV doses ranging from 57-829 microW. sec/cm(2), and sampled with a six-stage Andersen culture plate impactor at RHs ranging from 25-95%. RESULTS: Percent survival for both organisms was inversely related to UV dose. Serratia marcescens was more susceptible to UV than BCG under all conditions. More than 95% of the bacterial aerosol particles were 1.1-4.7 microm in aerodynamic diameter, and particles sizes increased from low (25-36%) to high (85-95%) RH. The count median diameter ranged from 1.9-2.6 microm for Serratia marcescens and from 2.2-2.7 microm for BCG as RH increased. For both Serratia marcescens and BCG, resistance to UV increased as RH increased. The UV resistance of both Serratia marcescens and BCG aerosols dramatically increased at RH higher than 85%. CONCLUSIONS: Our results indicate that differences in UV dose, kinds of microorganisms, airborne particle size and RH affect UV susceptibility.     

Orthopaedic infections by Serratia marcescens: a report of seven cases

In recent decades, Serratia marcescens has been established as a cause of infections difficult to treat, and several outbreaks of nosocomial infections have been reported, mostly from the USA. However, serratia infections affecting bones and joints are very rare; only a few such cases have previously been reported from Europe. We report 7 patients with orthopaedic infections by S. marcescens chiefly of nosocomial origin where previous antibiotic therapy apparently was a predisposing factor. The clinical course was generally protracted, often requiring repeated surgical interventions. Also, in some cases adequate therapy was considerably delayed as serratia was considered to be a nonpathogenic saprophyte. Multiresistance to antibiotics was a major clinical problem. However, the third generation cephalosporins are often effective against serratia and the aminoglycosides can thus be avoided. The increased use of prophylactic antibiotic therapy in orthopaedic surgery may bring about an increase in the incidence of infections by multiresistant microorganisms in orthopaedic wards.     

Iron acquisition from heme and hemoglobin by a Serratia marcescens extracellular protein.

Several pathogenic bacteria are able to use heme and hemoproteins as iron sources independent of siderophore production by mechanisms involving outer membrane heme-binding proteins and heme transport systems. Here we show that Serratia marcescens has such a property and we identify an extracellular heme-binding protein, HasA (for heme acquisition system), allowing the release of heme from hemoglobin. This protein is secreted by S. marcescens under conditions of iron depletion and is essential for heme acquisition.     

Study on new quinolone-resistant strains isolated from urine--annual changes of its frequency and the relation to drug volume

There is concerned that the new quinolone-resistant strains have increased along with its widespread usage. We analysed the annual changes in frequency of ofloxacin-resistant strains isolated from urine in the past four years at two different types of hospitals, department of urology in Sapporo Medical College and Muroran City Hospital, since the usage of these agents seem to be related to the annual changes of the frequencies. The results were summarised as follows: 1) In the two hospitals, drug volume of the new quinolones had been increased, in particular, the past six years from 1984. 2) The annual changes in frequency of ofloxacin-resistant Staphylococcus aureus have been increasing from 0 to 41.2 percent in Sapporo Medical College and 16.7 to 96.7 percent in Muroran City Hospital. The frequency of ofloxacin-resistant Pseudomonas aeruginosa also have been increasing from 24 to 66.7 percent in Sapporo Medical College and 37.5 to 81.8 percent in Muroran City Hospital. 3) The frequency of ofloxacin-resistant indole positive Proteus spp. and Serratia marcescens for four years at Sapporo Medical College (indole positive Proteus spp.: 0-1.8 percent, Serratia marcescens: 10-43 percent) was very different from that at Muroran City Hospital (indole positive Proteus spp.: 65-82 percent, Serratia marcescens: 71-100 percent). The difference seems to be caused by the hospital acquired infection.     

Two nosocomial outbreaks of sepsis caused by Serratia marcescens, which occurred in July 1999 and January 2002--Tokyo

Two nosocomial outbreaks of sepsis caused by Serratia marcescens, which occurred in Tokyo were the following cases. CASE A: In July 1999, 10 inpatients admitted to the third floor ward of the General Hospital A, developed sudden onset of high fever, coagulation disorders (disseminated intravascular coagulation), and acute renal failure, of which 5 died. Twenty-one strains of Serratia marcescens were isolated from the inpatient's blood and urine, nurse fingers and environmental samples from floor and cooling tower. Serratia infection was strongly suspected as the cause of sepsis. These cases were defined as "inpatients who developed fever 38 degrees C or more during July 26 to 29 and from whom S. marcescens was isolated by blood culture". Ten isolates were detected from the blood. In order to investigate the background of S. marcescens isolation in the hospital and to compare molecular and biochemical characteristics of S. marcescens, cultures were attempted from samples of other inpatients and staffs and hospital environment. Those were classified into 9 groups by various different typings: biotyping with Api Rapid 20; susceptibility typing of antimicrobial agents tested; pulsed-field gel electrophoresis (PFGE) typing of SpeI- or Xba I-restricted chromosome. All 10 isolates causing sepsis were found to be in the same group. CASE B: In January 2002, 24 inpatients, admitted to Neurosurgical Hospital B, developed sudden onset of high fever, of which 7 died. S. marcescens was isolated from a towel, environmental samples and inpatients. These cases were defined as "inpatients who developed fever of 38.5 degrees C and S. marcescens isolated by blood culture". Twelve strains were isolated from the blood samples in 12 cases. In order to investigate the background of S. marcescens isolation in the hospital, cultures were attempted from other inpatient's urine and environmental samples from medical tape, Tshake and a towel. These isolates were classified into 3 groups by the previous typings; biotyping with Api Rapid 20; susceptibility typing of antimicrobial agents tested; and PFGE typing. All 12 isolates in 12 cases were found to be in the same group. These cases of 2 nosocomial outbreaks of sepsis were defined as "in-patient who developed high fever and S. marcescens isolated by blood culture". However in both cases transmission routes of Serratia infection remain unknown by field investigation.     

Serratia marcescens as a pathogen of tsetse flies.

When applied to the ears of rabbits used as hosts for tsetse flies, the bacterium Serratia marcescens produced significant mortality in populations of Glossina m. morsitans and G. pallidipes. After being ingested during the blood meal, cells of S. Marcescens multiplied in the intestine of the flies and entered the hemocoel. Using the brush method of applying the bacterium, 100% mortality of both Glossina species occurred within 10 days after application. In newly killed flies, the bacteria could be found free in the hemocoel as well as in the fat body and blood cells. The supernatant of a liquid culture of S. marcescens did not produce fly mortality when applied to rabbit ears. The results indicate that S. marcescens is able to invade the hemocoel of "normal" laboratory-reared tsetse flies.     

Ventriculoperitoneal shunt infection due to Serratia marcescens

Serratia marcescens is an opportunistic Gram-negative bacillus that is most often associated with infections of the respiratory tract, urinary tract, wounds, and bloodstream. Infections of the central nervous system (CNS) with this pathogen are exceedingly infrequent. Even more rare is the association of S. marcescens with infections of ventriculoperitoneal (VP) shunts. To the best of our knowledge, we describe in this report not only the first case of a VP shunt infection by S. marcescens in an adult, but also the first case of a VP shunt infection by this organism in the absence of bowel perforation.