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Orthopaedic infections by Serratia marcescens: a report of seven cases
Abstract:
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.
Insights
Serratia marcescens bone infections are rare but difficult to treat nosocomial infections. Prophylactic antibiotics may increase risk of these multiresistant bacterial infections.
Area of Science:
- Orthopaedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Serratia marcescens is an opportunistic pathogen causing difficult-to-treat nosocomial infections.
- Bone and joint infections by Serratia marcescens are exceptionally rare, with few European cases reported.
Observation:
- This study reports seven cases of orthopaedic infections caused by Serratia marcescens, primarily of nosocomial origin.
- Previous antibiotic therapy was identified as a potential predisposing factor in these cases.
- The clinical course was often prolonged, necessitating multiple surgical interventions.
Findings:
- Serratia marcescens infections were frequently misdiagnosed as nonpathogenic, delaying adequate treatment.
- Multidrug resistance was a significant challenge in managing these infections.
- Third-generation cephalosporins demonstrated efficacy, potentially obviating the need for aminoglycosides.
Implications:
- The rising use of prophylactic antibiotics in orthopaedic surgery may contribute to an increase in multiresistant infections.
- Awareness of Serratia marcescens as a pathogen in orthopaedic settings is crucial for timely diagnosis and treatment.
- Effective antibiotic strategies, including cephalosporins, are vital for combating these resistant infections.