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The story of serratia marcescens: pathologic risk factors in breast implant surgery
Caroline A Yao1, Diana Wang1, David A Kulber2
1Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Abstract:
Serratia marcescens (S. marcescens) emerged as an opportunist in the setting of immunodeficiency in the 1970s, when serious infections occurred in San Francisco hospitals after USA. Navy experiments had aerosolized the bacteria to study biologic warfare. We investigate the risks of S. marcescens in San Franciscans who undergo mastectomy with implant reconstruction. From 2007 to 2011, the senior author took breast capsule cultures for all patients at the time of tissue expander exchange/explant. Of the 142 women who had reconstruction, 23 had positive cultures. Only the two patients who were positive for S. marcescens developed clinical infections that required explantation. Both had postoperative chemotherapy with transient neutropenia, and both had close ties to San Francisco. Clinical signs of infection emerged for both patients months after initial surgery, despite having previously well healed incisions. Other patients were culture positive for Pseudomonas, Proteus, Enterococcus and MRSA and did not develop require explant. While the link between San Francisco and S. marcescens is controversial, a patient's geography is a simple screening tool when considering postoperative risks, especially in the immunocompromised. Closer monitoring for neutropenia during chemotherapy, and a lower threshold to administer S. marcescens targeted antibiotics may be warranted in these patients.
Insights
Serratia marcescens infections are a risk for immunocompromised patients undergoing mastectomy reconstruction, particularly those with ties to San Francisco. Prompt antibiotic treatment and neutropenia monitoring are crucial.
Area of Science:
- Infectious Diseases
- Surgical Oncology
- Microbiology
Background:
- Serratia marcescens (S. marcescens) is an opportunistic pathogen, historically linked to San Francisco following biological warfare experiments.
- Immunocompromised individuals are at increased risk for serious S. marcescens infections.
Purpose of the Study:
- To investigate the risk of S. marcescens in patients undergoing mastectomy with implant reconstruction.
- To evaluate the clinical significance of S. marcescens in breast reconstruction patients.
Main Methods:
- Breast capsule cultures were obtained during tissue expander exchange/explant in 142 women from 2007-2011.
- Positive cultures were analyzed for bacterial species and correlated with clinical outcomes.
- Patient geography and treatment history (chemotherapy) were considered.
Main Results:
- Twenty-three out of 142 women had positive cultures.
- Only two patients positive for S. marcescens developed infections requiring explantation.
- Both S. marcescens infected patients had recent postoperative chemotherapy and transient neutropenia.
Conclusions:
- S. marcescens poses a risk for mastectomy reconstruction patients, especially those who are immunocompromised and reside in or have ties to San Francisco.
- Geography may serve as a screening tool for postoperative risks.
- Increased monitoring for neutropenia and early targeted antibiotic administration for S. marcescens are recommended for at-risk patients.
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