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Serratia bacteremia
E Bouza1, M García de la Torre, A Erice
1Infectious Disease Unit (Microbiology Service), Centro Especial Ramón y Cajal, Madrid, Spain.
Abstract:
During a 6-yr period, 146 patients at our institution had Serratia bacteremia (3.8% of the total number of episodes of bacteremia), with an incidence of 1.24/1000 admitted patients. We chose a random group of 50 cases for clinical analysis in the present study. The disease was community-acquired in 8% of the cases and nosocomially-acquired in the remaining 92%. The bacteremia was unimicrobial in 84% and part of a polymicrobial bacteremia in 16% of the episodes. The most frequently isolated species of the Serratia genus was S. marcescens. Portals of entry, in decreasing order of frequency, were: urinary, unknown, respiratory, and surgical wound infections. Clinically, the most frequent finding was fever (100%). Shock occurred in 28% of the patients, and none of our cases showed evidence of disseminated intravascular coagulation. We found 62% of Serratia isolates resistant to gentamicin. Overall mortality was 38% and factors associated with a poor prognosis were: severity of the underlying disease, critical clinical situation at onset of bacteremia, presence in the intensive care unit (I.C.U.), occurrence of shock or polymicrobial bacteremia, portal of entry in the respiratory tract, and inadequate treatment.
Insights
Serratia bacteremia, often hospital-acquired, presents with fever and shock. High resistance to gentamicin and factors like critical illness predict poor outcomes, highlighting treatment challenges.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Serratia bacteremia is a significant cause of bloodstream infections.
- Understanding its epidemiology and clinical features is crucial for patient management.
Purpose of the Study:
- To analyze the clinical characteristics, outcomes, and prognostic factors of Serratia bacteremia.
- To assess antimicrobial resistance patterns of Serratia isolates.
Main Methods:
- Retrospective analysis of 50 patients with Serratia bacteremia over a 6-year period.
- Identification of the most frequent species (Serratia marcescens) and portals of entry.
- Evaluation of clinical findings, including fever, shock, and disseminated intravascular coagulation.
Main Results:
- 92% of cases were nosocomially-acquired, with urinary and respiratory tracts as common entry points.
- Fever was universal; shock occurred in 28%.
- 62% of isolates showed gentamicin resistance, and overall mortality was 38%.
Conclusions:
- Serratia bacteremia, particularly hospital-acquired, is associated with high mortality.
- Factors like underlying disease severity, shock, polymicrobial bacteremia, respiratory infection, and inadequate treatment predict poor prognosis.
- High rates of gentamicin resistance necessitate careful antibiotic selection.