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Serratia Infections in Burn Care
David Wallace1,2, Alan D Rogers1,2
1Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
Abstract:
Serratia marcescens is an opportunistic nosocomial pathogen with significant implications for burn care due to its multidrug resistance, virulence, and ability to colonize hospital environments. This retrospective study, conducted at an American Burn Association Verified Burn Centre, reviewed 22 cases of S. marcescens infections from 2015 to 2020. Patients exhibited a mean total body surface area (TBSA) burned of 28% (range: 2%-71%), with 68% sustaining burns >20% TBSA and 40.9% presenting with inhalation injuries. The pathogen was most commonly isolated from sputum (36%) and burn wound tissue (50%), with a mean time to positive culture of 8.7 days. Early-onset infections were associated with increased mortality, particularly in patients with major burns, as five out of seven such individuals succumbed to infection. The overall mortality rate was 23%, despite timely antibiotic administration. Targeted topical antimicrobials, such as Dakin's solution, nanocrystalline silver, and polyhexamethylene biguanide, offer potential benefits but lack robust evidence for optimal use. Stronger clinical data are needed to guide their application and improve outcomes. These findings underscore the need for enhanced surveillance, refined treatment strategies, and research into S. marcescens management in burn care.
Insights
Serratia marcescens infections pose a high mortality risk in burn patients, especially with early-onset infections and major burns. Further research is needed to improve treatment strategies for this multidrug-resistant pathogen.
Area of Science:
- Infectious Diseases
- Burn Care
- Critical Care Medicine
Background:
- Serratia marcescens is an opportunistic nosocomial pathogen frequently encountered in hospital settings.
- Its multidrug resistance and virulence present significant challenges in managing burn wound infections.
- Colonization by S. marcescens can lead to severe complications in burn patients.
Purpose of the Study:
- To retrospectively analyze cases of Serratia marcescens infections in burn patients.
- To identify risk factors, clinical characteristics, and outcomes associated with S. marcescens infections in this population.
- To evaluate the effectiveness of current treatment strategies and highlight areas for improvement.
Main Methods:
- Retrospective review of 22 cases of S. marcescens infections at a verified burn center (2015-2020).
- Analysis of patient demographics, burn severity (total body surface area - TBSA), inhalation injuries, and infection sites.
- Correlation of infection onset, pathogen isolation time, and patient outcomes, including mortality.
Main Results:
- Patients had a mean TBSA burn of 28%, with 68% having burns >20% TBSA and 40.9% with inhalation injuries.
- S. marcescens was most commonly isolated from burn wound tissue (50%) and sputum (36%).
- Early-onset infections in major burn patients were associated with significantly increased mortality (5/7 deaths). Overall mortality was 23% despite timely antibiotics.
Conclusions:
- Serratia marcescens infections represent a critical threat in burn care, linked to high mortality rates.
- Current topical antimicrobial strategies lack robust evidence for optimal use, necessitating further investigation.
- Enhanced surveillance and refined treatment protocols are crucial for managing S. marcescens in burn patients.
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