Serratial bacteremia in the surgical patient

A 42-month review has identified 32 surgical patients that had 45 episodes of Serratia marcescens bacteremia. Patients were identified in many surgical specialties. The primary focuses of infection were the urinary tract, intravascular devices, sputum, and soft tissue. In five patients, no focus was identifiable. Nine patients had polymicrobial sepsis with other bacteria or Candida. Of 41 isolates studied, five were resistant to all antibiotics that were commercially available. Only 76 per cent were sensitive to amikacin, 63 per cent to gentamicin, and 46 per cent to tobramycin. Statistically fewer patients died when an aminoglycoside and an expanded-spectrum penicillin were used in combination. The 44 per cent mortality rate of this group of patients indicates that environmental control, behavioral modification of health care professionals, and a more rationale use of broad-spectrum antibiotics are necessary to prevent this morbid complication.