Antibiotic-resistant Serratia marcescens infection in a hospital.

Over a 12-month period, 74 isolates of Serratia marcescens were obtained from various sources at Tygerberg Hospital. The majority of these isolates were from catheterized patients with urinary tract infections, and were non-pigmented and resistant to all antibiotics tested, excepting amikacin and neomycin. All isolates transferred resistance to tobramycin, gentamicin and tetracycline by conjugation to Escherichia coli recipients as separate markers at low frequency. A non-self-transmissible plasmid conferring resistance to kanamycin, ampicillin and gentamicin was mobilized from Serratia species to E. coli, and became fully self-transmissible in subsequent matings.     

Serratia marcescens pneumonia.

Though rare, Serratia marcescens pneumonia is being reported with increasing frequency, especially in patients in intensive care units. We report three cases of S. marcescens pneumonia that presented striking similarities for age, group, type of surgical procedure, and microbiological, hemodynamic, and respiratory patterns. All patients survived after prolonged ventilatory support.     

Bilateral chronic ureteritis associated with Serratia marcescens.

To our knowledge this is the first case of bilateral obstructive uropathy caused by nonspecific chronic ureteritis to be reported. Prior to operation the bilateral involvement was throught to be due to a tuberculous infection or retroperitoneal fibrosis. The diagnostic difficulties were similar to those previously reported in the unilateral involvement. The focus of the infective organism found was Serratia marcescens which originated in the right kindey.     

Spontaneous bacterial peritonitis causing Serratia marcescens and Proteus mirabilis ventriculoperitoneal shunt infection. Case report

The authors report their experience treating a polymicrobial ventriculoperitoneal (VP) shunt infection in a developmentally delayed 21-year-old woman. Cerebrospinal fluid (CSF) cultures grew Serratia marcescens and Proteus mirabilis. On admission and throughout her hospitalization, results of physical examination of her abdomen were normal, and radiographic studies showed no evidence of bowel perforation or pseudocyst formation. Contrast-enhanced computed tomography of the abdomen revealed a small fluid collection. After a course of intravenous gentamicin and imipenem with cilastatin in conjunction with intrathecal gentamicin, the infection was resolved and the VP shunt was reimplanted. Although VP shunt infections are not uncommon, S. marcescens as a causative agent is exceedingly rare and potentially devastating. Only two previous cases of S. marcescens shunt infection have been reported in the literature. Authors reporting on S. marcescens infections in the central nervous system (CNS) have observed significant morbidity and death. Although more common, the presence of P. mirabilis in the CSF is still rare and highly suggestive of bowel perforation, which was absent in this patient. Spontaneous bacterial peritonitis was the likely source from which these bacteria gained entrance into the VP shunt system, eventually causing ventriculitis in this patient. The authors conclude that in light of the high morbidity associated with S. marcescens infection of the CNS, intrathecal administration of gentamicin should be strongly considered as part of first-line therapy for S. marcescens infections in VP shunts.     

Contrasting perspectives on pain following hand injury.

The purposes of this article are 1) to compare contrasting ways of documenting pain, 2) to identify the usefulness of information each method provides, and 3) to examine implications for hand therapy. Participants are tracked for 12 months in an ongoing study of Adaptation to Hand Injury that incorporates quantitative measures of both intensity and functional impact of pain, as well as semistructured qualitative Adaptation Interviews that elicit and document patients' responses to pain and injury experience. Each method of documenting pain tells us something important. Numeric measures of pain intensity (Visual Analog Scale) allow us to document change over time and identify relationships between intensity and self-reported changes in daily life as documented in a structured questionnaire (Disabilities of Arm, Shoulder, and Hand). Qualitative interviews provide an individual perspective on responses to pain and disability and the personal beliefs and experiences that influenced the responses of each unique individual. Findings support the importance of studying more about the clinical behaviors of our patients for better treatment outcomes and recommend the use of qualitative research in helping us to uncover this knowledge.     

Serratia marcescens cellulitis in a patient on hemodialysis.

Serratia marcescens is an infrequent cause of cellulitis with only 5 reported cases. Four of the 5 patients were immunocompromised. Additionally, the cellulitis usually occurred at a site contiguous with a wound. We report a case of S. marcescens cellulitis in a patient with end-stage renal disease on chronic hemodialysis. The initial presentation was a soft tissue infection that progressed to septic shock. Ultimately, the patient responded to antibiotics and surgical debridement of infected tissue. This case serves as a reminder to consider infections due to gram-negative bacilli as a cause of cellulitis in immuno-compromised patients regardless of the presentation.     

Serratia marcescens endocarditis treated with ceftazidime. A case report

A 14-year-old Black girl developed Serratia marcescens endocarditis following a mitral valve repair. This was refractory to treatment with several courses of antibiotics and valve replacement, and was eventually cured after a second valve replacement and treatment with ceftazidime (GR 20263 Glaxo), a new cephalosporin derivative.     

Sexual dysfunction following traumatic hand injury

The purpose of this study was to examine the frequency and nature of sexual dysfunction present in a population with traumatic hand injuries. One hundred twenty patients were seen for psychological evaluation during the first two months postinjury. Forty-nine percent (59) reported sexual dysfunction during the initial two months. Six months postinjury 19% (23) continued to have sexual dysfunction. At that time a more extensive sexual history was obtained. Three categories of sexual dysfunction were identified following interviews: (1) impotence (35% or 8 patients), (2) reduced sexual desire (65% or 15), and (3) rejection of sexual contact by the partner (39% or 9). Four major causes of impaired sexual functioning were reported: (1) pain (22% or 5 patients), (2) deformity anxiety (52% or 12), (3) replant anxiety (9% or 2), and (4) contagious anxiety (39% or 9). The results of this study indicate that persistent sexual dysfunction may be a major difficulty following hand trauma. The type of dysfunction as well as the perceived cause of dysfunction are not the same for each case. Consideration of each is necessary to design efficacious intervention strategies.