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Published on: August 12, 2020
Case-control analysis of endemic Serratia marcescens bacteremia in a neonatal intensive care unit
Matthew J Bizzarro1, Louise-Marie Dembry, Robert S Baltimore
1Divisions of Perinatal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA.
Background:
Serratia marcescens is an opportunistic gram-negative rod which typically infects compromised hosts.
Objectives:
To identify risk factors, signs, and outcomes associated with non-epidemic S marcescens bacteremia in a neonatal intensive care unit (NICU).
Methods:
The records of infants with S marcescens bacteremia while in the Yale-New Haven Hospital NICU from 1980-2004 were reviewed. A matched case-control study was performed by comparing each case of S marcescens to 2 uninfected controls and 2 cases of Escherichia coli bacteremia.
Results:
Twenty-five sporadic cases of S marcescens bacteremia were identified. Eleven available isolates were determined to be different strains by pulse field gel electrophoresis. Infants with S marcescens bacteremia had median gestational age and birth weight of 28 weeks and 1235 grams, respectively. Compared to matched, uninfected controls, infants with S marcescens bacteremia were more likely to have had a central vascular catheter (OR = 4.33; 95% CI (1.41 to 13.36)) and surgery (OR = 5.67; 95% CI (1.81 to 17.37)), and had a higher overall mortality (44% vs 2%; OR = 38.50; 95% CI (4.57 to 324.47)). Compared to E coli matched controls, infants with S marcescens bacteremia had later onset of infection (median of 33 days of life vs 10; p<0.001), prolonged intubation (OR = 5.76; 95% CI (1.80 to 18.42)), and a higher rate of CVC (OR = 7.77; 95% CI (2.48 to 24.31)) use at the time of infection. A higher rate of meningitis (24% vs 7%; OR = 3.98; 95% CI (1.09 to 14.50)) was observed with S marcescens bacteremia compared to E coli.
Conclusions:
S marcescens bacteremia occurs sporadically in the NICU, primarily in premature infants requiring support apparatus late in their hospital course. Associated meningitis is common and mortality high.
Insights
Serratia marcescens bacteremia in premature infants is linked to central vascular catheters and surgery, leading to high mortality. Meningitis is a common complication in these vulnerable neonates.
Area of Science:
- Neonatal Intensive Care Unit (NICU) Medicine
- Infectious Diseases
- Microbiology
Background:
- Serratia marcescens is an opportunistic gram-negative bacterium.
- It commonly affects immunocompromised individuals.
- This study focuses on non-epidemic S. marcescens bacteremia in neonates.
Purpose of the Study:
- To determine risk factors, clinical signs, and outcomes of S. marcescens bacteremia in a NICU.
- To compare S. marcescens bacteremia with other infections in neonates.
Main Methods:
- A retrospective case-control study was conducted.
- Infants with S. marcescens bacteremia were compared to uninfected controls and infants with Escherichia coli bacteremia.
- Data were collected from 1980-2004.
Main Results:
- Twenty-five sporadic cases of S. marcescens bacteremia were identified.
- Risk factors included central vascular catheter use and surgery.
- Mortality was significantly higher (44%) in infants with S. marcescens bacteremia compared to controls (2%).
- Meningitis occurred in 24% of S. marcescens cases versus 7% of E. coli cases.
Conclusions:
- Serratia marcescens bacteremia occurs sporadically in NICU settings.
- Premature infants requiring significant medical support are primarily affected.
- High mortality rates and a significant incidence of meningitis are associated with S. marcescens bacteremia in neonates.
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