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Intracranial Serratia infection in preterm newborn infants.

Four cases of cerebral Serratia infection in preterm infants were diagnosed with the aid of real-time sector sonography. Three cases had brain abscesses and one case had ventriculitis. In two cases brain abscesses had ruptured into the ventricles. Serratia brain abscess was common in our series of brain abscesses. Sonographic patterns of cerebritis, abscess formation, and ventriculitis correlated well with computed tomographic scans. Bedside cerebral sonography proved to be useful for the diagnosis, location, and follow-up of intracranial Serratia infection.

Brain Abscess↗

Serratia endocarditis. A follow-up report.

Seventeen new cases of Serratia marcescens endocarditis observed in the San Francisco Bay Area since June 1974 are presented. Fifteen patients had a history of illicit intravenous drug use and four patients had prosthetic heart valves. Seven patients with infection of right-sided heart valves did well, although surgery was required in two for persistent fever or recurrent pulmonary emboli. Only three of ten patients with left-sided infection survived despite synergistic antibiotic combinations and high serum bactericidal titers. Fifteen isolates of Serratia from patients with endocarditis were serotyped, and none of these serotypes corresponded to the pigmented strain aerosolized by the US Army in the Bay Area in 1951. The isolation of the same Serratia strain from two patients and their shared injection paraphernalia provided insight into the pathogenesis of endocarditis in the intravenous drug user. A revised therapeutic approach to this difficult infection is presented.

California↗

[Free proteolytic activity from Serratia marcescens. II. Kinetics of production and mechanism of induction].

This paper shows that Serratia marcescens WF yields free proteolytic activity partially associated to growth, i.e. when the maximal rate of growth is reached, when it was growing in a saline medium supplemented with casein peptone. When the culture medium was utilized for a second time after it was used up (exhausted medium), growth and yield of free proteolytic activity showed the same partial association. With a protein medium containing peptides from 1000 to 5000 of molecular weight, from casein peptone, growth and yield of free proteolytic activity were partially associated too. In this paper, we demonstrated that Serratia marcescens WF yields free proteolytic activity only when growth rate is decelerating and under no growth conditions. We also demonstrated than the inducer structure acts gratuitously, because it cannot be used like a carbon and/or energy source. The structural form of the true inducer remains to be established. Finally, we propose that when growth rate is decelerating, or under no growth conditions, Serratia marcescens WF yields free proteolytic activity to obtain nitrogen from protein sources, apparently as the only function.

Bacterial Proteins↗

Natural antibiotic susceptibility of strains of Serratia marcescens and the S. liquefaciens complex: S. liquefaciens sensu stricto, S. proteamaculans and S. grimesii.

The natural susceptibility of 77 strains of Serratia marcescens and 41 strains of the S. liquefaciens complex (S. liquefaciens sensu stricto (n=21), S. grimesii (n=10), S. proteamaculans (n=10)) to 70 antibiotics was examined using a microdilution procedure in Isosensitest broth (all strains) and cation-adjusted Mueller Hinton broth (some strains). All species were naturally resistant to benzylpenicillin, oxacillin, cefaclor, cefazolin, cefuroxime, numerous macrolides, lincosamides, streptogramins, glycopeptides, rifampicin and fusidic acid. Uniform natural sensitivity was found to most aminoglycosides, several acylureidopenicillins, ticarcillin, newer cephalosporins, carbapenems, aztreonam, quinolones and antifolates. Species-related differences in susceptibility affecting clinical assessment criteria were found for several agents. S. marcescens was less susceptible to some aminoglycosides than species of the S. liquefaciens group. It was the only species that was uniformly naturally resistant to tetracycline, amoxycillin, amoxycillin/clavulanate and loracarbef. Species of the S. liquefaciens group were naturally resistant and intermediate or naturally intermediate to the latter agents. Differences in susceptibility among the species of the S. liquefaciens complex were generally small. S. proteamaculans was most susceptible to sulphamethoxazole. S. liquefaciens sensu stricto was less susceptible than S. grimesii and S. proteamaculans to tetracyclines, chloramphenicol and nitrofurantoin; it was the only species uniformly naturally resistant to fosfomycin. This study suggested that all species examined probably express chromosomally-encoded AmpC beta-lactamases, but the amount of enzyme may vary from species to species. The naturally-occurring low-level expression of the S. marcescens aminoglycoside 6'-acetyltransferase AAC(6')-Ic and its absence in other Serratia spp. was supported by the data. All species of the S. liquefaciens complex should be considered as probable agents of human diseases.

Anti-Bacterial Agents↗

The Pathogenicity of Serratia Strains to Lucilia sericata (Diptera: Calliphoridae)

Adult blowflies, Lucilia sericata, were tested for susceptibility to 11 strains of Serratia marcescens, 2 strains of Serratia liquefaciens, and 1 strain of Serratia entomophila in a series of 14 laboratory bioassays. Most bacterial strains were initially isolated from insects. S. marcescens strains were characterized to biotype level. Most strains conformed to biotype A2a, the group most commonly associated with insects. Flies were held individually in small tubes and fed bacterial suspensions containing approximately 1 x 10(9) bacteria ml-1 in a single 24-hr feeding period. For the remainder of the experiment, flies were fed sucrose solution. Eight of the S. marcescens strains caused significant mortality (P < 0.05-0.001), measured as death rate compared to untreated flies. Four strains had no effect on the flies (P > 0.05). The time taken to reach 50% mortality (LT50) ranged from 6.38 to 7.49 days for the pathogenic S. marcescens strains compared to LT50s of 8.81-11.73 days for the nonpathogenic strains, which did not differ significantly from the untreated control flies (LT50 of 10.38 days). After 7 days, mortality caused by the pathogenic strains ranged from 21 to 45% of treated insects. One strain of S. liquefaciens also caused significant mortality while the other was nonpathogenic. No mortality resulted from treatment of flies with S. entomophila.

Journal Article↗

Comparison of Bacillus subtilis and Serratia marcescens as protease producers under different operating conditions.

Two microorganisms, Bacillus subtilis and Serratia marcescens, have been selected in order to assess their ability to produce proteases. First, their performances have been studied using three media providing different levels of the main nutrients (complex, semi-defined and defined). The optimal absolute production was obtained in the complex media, while maximum protease activity per cell weight appeared in defined medium for Bacillus and in semi-defined and complex media for Serratia. Then, the effects of applying different environmental conditions to the cells were studied. The two microorganisms were immobilised in calcium alginate beads, protease production by these systems was assessed in the previously tested culture media, and the performances in free and immobilized operating conditions were compared. The richest medium seemed to be the best one in terms of absolute protease production, although the use of semi-defined or defined media could be considered more appropriate, in order to minimise growth of cells leaked from the support, and therefore downstream processing cost. Productivity was slightly higher in free cultures than in immobilized cultures, and retention of enzyme within the alginate beads was detected in the latter, indicating the occurrence of diffusional limitations. In all the cases studied, Serratia marcescens appeared as a better protease producer than B. subtilis, in terms of absolute production. This fact could be related to the different cell growth levels observed for the two microorganisms.

Journal Article↗

Genomic Insights Into Multidrug-Resistant Foodborne Serratia liquefaciens Strains Carrying mcr-9 and Comparative Genomic Analysis of Novel Biosynthetic Gene Clusters.

Serratia liquefaciens is an opportunistic nosocomial pathogen with a wide range of antibiotic resistance patterns. This study reports the characterization of the first mcr-9-positive S. liquefaciens strains, 35E-19E1 and CST-066, isolated from meat products in Japan. The strains were screened for the presence of &#x3b2;-lactamases, plasmid-mediated mobile colistin resistance (mcr) genes, and carbapenemase-encoding genes using PCR. Antimicrobial susceptibility was tested using the broth microdilution method. The strains exhibited multidrug resistance (MDR) phenotypes to third-generation cephalosporins, cephamycin, fosfomycin, and other clinically important antimicrobials. Genomic DNA sequencing showed that the genome sizes of CST-066 and 35E-19E1 are 5,529,704 and 5,261,506&#x2009;bps, respectively. mcr-9 was identified on a chromosome within a genetic environment that included the two-component system qseBC, which plays a key role in the signaling network that triggers colistin resistance in Enterobacterales. Downstream genome analysis revealed a 1695-bp eptB-like kdo2-lipid phosphoethanolamine transferase, which is involved in intrinsic polymyxin resistance mechanisms in Serratia spp. The strain 35E-19E1 carries five CRISPR-Cas enzymes that are essential for adaptive immunity in bacteria, allowing defense against invading elements. Functional analysis using subsystem technology revealed that both strains possess subsystem features responsible for invasion and adhesion within the host biomes. Genome mining using antiSMASH and BAGL4 revealed various biosynthetic gene clusters, responsible for secondary metabolite synthesis. Notably, we identified novel gene clusters, mainly nonribosomal peptide synthetases, in both the strains, indicating their potential to produce bioactive compounds. Although the presence of mcr-9 in Serratia may not be of clinical significance because of natural resistance of the strain to polymyxins, we shed light on the genomic characteristics of this MDR pathogen and the potential spread of mcr-9 among other bacterial species. The emergence of mcr-9 in drug-resistant S. liquefaciens provides significant insights, underscoring the need for increased surveillance of this pathogen.

biosynthetic gene cluster↗

Serratia infections in patients with neutropenia.

We report on six cases of sepsis caused by Serratia marcescens in patients with neutropenia. Four cases showed an additional involvement of the upper respiratory and digestive tract with oral and pharyngeal mucositis, haemorrhagic laryngo-tracheo-bronchitis, and oedematous swelling of the face. One patient showed a Serratia marcescens carrier state in the pharynx over a period of months without neutropenia. The isolated strains showed a broad spectrum of resistance against antibiotics; only aztreonam and amikacin were effective in vitro against all isolates.

Adolescent↗

Brain abscesses after Serratia marcescens infection on a neonatal intensive care unit: differences on serial imaging.

Serratia are known to be a possible cause of severe cerebral infections in neonates. We describe imaging of three premature infants infected with Serratia marcescens. Born in the 31( st), 25( th) and 28( th) weeks of gestation, they presented with signs of septicaemia on postnatal days 9, 24 and 32. Initial sonography showed cysts in the first child, two areas with anechoic centre and echogenic rim in the second, and several echogenic areas in the third. Lesions were seen on CT, of low density in two cases and minimally increased density in the third. MRI in the first patient showed cysts with incomplete contrast enhancement of the lesions, while patient 2 showed five ring-enhancing fluid-containing lesions with thick walls. In the third patient two abscesses with contrast enhancement and several high-signal spots were seen. We discuss the pathophysiology of the lesions and the impact of the various imaging methods.

Brain Abscess↗

Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: a clinical, epidemiologic, and laboratory perspective.

BACKGROUND: Serratia marcescens is an aerobic gram-negative bacillus belonging to the family Enterobacteriacea. Infections caused by S marcescens may be difficult to treat because of their resistance to a variety of antibiotics, including beta-lactams and aminoglycosides. METHODS: This study aimed to (1) identify the risk factors associated with the development of Serratia marcescens bacteriuria in neurosurgical intensive care units (NSICU); (2) genotype the pathogens to determine the source of infection; (3) compare these results with antibiograms; and (4) determine and implement appropriate control measures. A retrospective case-control study of the epidemiologic data, the surveillance of environmental cultures, and the genotyping of strains using arbitrarily primed polymerase chain reaction (AP-PCR) were performed at a 750-bed, tertiary care teaching hospital. Seventy-four bacteriuria patients were compared with 74 age/sex-matched control patients in the NSICU between March 2002 and March 2004. The factors assessed were patient demographics; duration of hospital stay; duration of indwelling catheter use before and during stay in the NSICU; chronic underlying illnesses (diabetes mellitus, cardiovascular disease, malignancy); other sites of infection; history of trauma; exposure to a nasogastric tube; mechanical ventilation; urinary catheterization; central venous catheterization; surgical drainage; tracheostomy; brain or spine surgery; and receipt of total parenteral nutrition (TPN), antimicrobials (beta-lactams, aminoglycosides, quinolones, carbapenems, vancomycins), or steroids. RESULTS: Patients with S marcescens bacteriuria were more likely to have a longer NSICU stay and other sites of infection. Environmental surveillance showed the handling of urine jugs to be the point source of contamination. Genotyping and antibiograms of 14 patients were the same except for those of 2 patients. CONCLUSION: The patient-related risk factors were identified, and a rapid identification of the organism was made. Heightened surveillance, infection control measures, and empiric therapy led to improved methods for handling urine jugs, which terminated the outbreak.

Anti-Bacterial Agents↗

Epidemiological investigation of a Serratia liquefaciens outbreak in a neurosurgery department.

Between February 2001 and March 2003, 17 patients from the neurosurgery department of the University Hospital of Rangueil (Toulouse, Southern France) developed Serratia liquefaciens infections. Due to the atypical antibiotype displayed by the clinical isolates (i.e. gentamicin resistance), an outbreak was suspected. Molecular analysis carried out by pulsed-field gel electrophoresis demonstrated a genetic link for all patients. Furthermore, the patient who introduced the epidemic Serratia strain was also identified and shown to be related to the two epidemic peaks observed during the outbreak period. Investigation failed to reveal a reservoir among the antiseptics and soaps, or among the mechanical ventilators used. However, when the colonization of patients was investigated, positive carriage was observed and could be considered as a potential risk for the spread of the epidemic strain. Due to the delay between antibiotherapy and S. liquefaciens colonization, a selection effect had to be considered. Finally, implementation of hygiene measures was accompanied by control of the outbreak.

Anti-Infective Agents, Local↗

Serratia Marcescens corneal ulcer as a complication of orthokeratology.

PURPOSE: To report a case of Serratia Marcescens corneal ulcer as a complication of orthokeratology treatment. METHODS: Case report. RESULTS: A 9-year-old male who underwent orthokeratology treatment for 6 months suffered from a corneal ulcer. The refractive state of lesion eye was -5.5D/-1.25D x 180 degrees, and visual acuity was hand motion at 30 cm. He wore a retainer lens, rigid gas permeable lens, overnight for 2 months before the corneal ulcer occurred. Ulcer became worse after tobramycin and gentamycin treatment for 2 days. After ciprofloxacin treatment, the ulcer healed and visual acuity recovered to 20/20 with spectacle correction. Cultures of the cornea tissue and contact lens storage solution both grew Serratia Marcescens, which was sensitive to ciprofloxacin. CONCLUSION: Overnight wearing of a rigid contact lens is a risk factor for a corneal ulcer.

Anti-Infective Agents↗

An outbreak due to Serratia marcescens in a neonatal intensive care unit typed by 2-day pulsed field gel electrophoresis protocol.

BACKGROUND: Serratia marcescens is a well-recognized nosocomial pathogen. The objective of the study was to describe typing results using a rapid pulsed field gel electrophoresis (PFGE) protocol and infection control measures during an outbreak of Serratia marcescens in a 24-bed, referral, neonatal intensive care unit (NICU) of a tertiary-care pediatric hospital. METHODS: Two patients with S. marcescens sepsis were identified in the NICU. Health care personnel of the unit were requested to reinforce infection control measures. Active surveillance was established to detect infected and/or colonized patients and environmental and staff reservoirs. Infected and colonized patients were cohorted on one side of the unit; admissions to NICU were limited. Isolates were typed with a short 2-day pulsed-field gel electrophoresis (PFGE) protocol. RESULTS: Thirty three patients were exposed during a period of 20 days. Ten S. marcescens isolates were obtained from six patients, in two from blood culture and in three from stool culture; a single clone was identified in four. S. marcescens was not isolated from environmental or staff cultures. CONCLUSIONS: PFGE results were obtained in 2 days, infection control measures were reinforced, outbreak was promptly interrupted, and the NICU remained opened.

Bacterial Typing Techniques↗

Aminoglycoside resistance patterns of Serratia marcescens strains of clinical origin.

Aminoglycoside resistance patterns of 147 Serratia marcescens strains of clinical origin were studied. All strains analysed belonged to three different bacterial populations. The periods of study and the institutions the strains were isolated from correlated significantly with the resistance patterns shown by the strains. The most frequent resistance patterns found were the following: ACC (6')-I at the Hospital Infantil de México (Children's Hospital of México), and ANT (2'') + AAC(6')-I at the Instituto Nacional de Pediatría (INPed or National Institute of Pediatrics) in Mexico City. Furthermore, the isolation frequency of aminoglycoside-sensitive strains decreased remarkably at the INPed over a 12-year period. These results suggest that there has been a selection of Serratia marcescens strains that are very resistant to aminoglycosides.

Aminoglycosides↗

An outbreak of multiply resistant Serratia marcescens: the importance of persistent carriage.

An outbreak of multi-resistant Serratia marcescens involving 24 patients occurred in a bone marrow transplant and oncology unit, from September 1998 to June 1999, of whom 14 developed serious infection. This is the first such outbreak described in a BMT unit. All isolates demonstrated the same antimicrobial susceptibility pattern and were the same unusual serotype O21:K14. The antimicrobial susceptibility profile showed reduced susceptibility to ciprofloxacin, gentamicin and piperacillin-tazobactam. As the latter two antimicrobials are part of our empiric therapy for febrile neutropenia, they were substituted with meropenem and amikacin during the outbreak. Investigation revealed breaches in infection control practices. Subsequently, the outbreak was contained following implementation of strict infection control measures. A prominent feature of the outbreak was prolonged carriage in some patients. These patients may have acted as reservoirs for cross-infection. This report also indicates that patients who become colonised with Serratia marcescens may subsequently develop invasive infection during neutropenic periods.

Adult↗

Characterization of Serratia marcescens surviving in disinfecting footbaths.

AIM: To determine if disinfecting footbaths in the food industry were contaminated with bacteria and to characterize some of the bacteria present. METHODS AND RESULTS: Bacterial strains were isolated from disinfecting footbaths containing TEGO 103G (amphoteric disinfectant) or TP-99 (alkyl amino acetate-based disinfectant) in five of six dairy factories. Fourteen strains identified as Cedecea spp. by their fatty acid composition were further characterized. Results from Rapid ID 32 E API analysis and 16S-rDNA-sequencing showed that all strains were Serratia marcescens. Unlike S. marcescens ATCC 13880, the isolates from disinfecting footbaths were not killed (<5 log10 reduction) by the recommended in-use concentration of TEGO 103G, TEGO 51 or benzalkonium chloride. Survival and multiplication in tap water with an in-use concentration of TEGO 103G was demonstrated for one of the strains. All strains were killed by the in-use concentrations of commercial disinfectants based on peracetic acid, hypochlorite, quaternary ammonium compounds and alkyl amino acetate (TP-99). There were no indications of cross-resistance between disinfectants and antibiotics. CONCLUSION: Serratia marcescens may survive and multiply in disinfecting footbaths containing TEGO 103G or alkyl amino acetate because of disinfectant resistance. SIGNIFICANCE AND IMPACT OF THE STUDY: Disinfecting footbaths may act as contamination sources in food factories and should not be used without regular hygienic monitoring.

Anti-Bacterial Agents↗

Epidemiological analysis of imipenem-resistant Serratia marcescens in hospitalized patients.

Our objective was to examine epidemiological characteristics of hospitalized patients with imipenem-resistant Serratia marcescens. We performed a case-control study using data collected from computerized databases and chart review. Molecular typing by pulsed field gel electrophoresis of available isolates was performed. One hundred and ten patients had Serratia spp isolated during the 23-month study period. Twelve were infected or colonized with S. marcescens resistant or of intermediate susceptibility to imipenem. Eleven of the 12 patients were detected during a seven-month period between August 1994 and February 1995, suggesting the possible occurrence of an outbreak. However, the patients were admitted to different wards and services and, in eight patients, imipenem-resistant S. marcescens were isolated within 48 h or admission. None of the patients had epidemiological links within other institutions. The 12 cases were not more likely to have been exposed to beta-lactam antibiotics, including imipenem, than patients with imipenem-susceptible isolates. Six isolates were available for typing by PFGE; three were indistinguishable or closely related whereas each of the other three isolates were unique. In conclusion both the prevalence of imipenem-resistant S. marcescens and its unusual epidemiologic characteristics warrant further study.

Boston↗

Nosocomial transmission of Serratia odorifera biogroup. 2: Case report demonstration by macrorestriction analysis of chromosomal DNA using pulsed-field gel electrophoresis.

OBJECTIVES: To investigate a cluster of Serratia odorifera in a cardiothoracic surgery unit (CTSU) and to evaluate the applicability of three typing methods for this species. DESIGN: During a surveillance surgical wound study, S odorifera was isolated from two patients in the CTSU. The patients' hospital charts were reviewed for the details of surgery and for common personnel, procedures, or medications. Cultures were obtained of water, soap, and unit dose medications from the CTSU, the operating room, and the surgical intensive care unit. The isolates' antibiograms, biotypes (Vitek identification card and API 20E), and patterns of chromosomal DNA (chrDNA) by pulsed-field gel electrophoresis (PFGE) were examined. S odorifera isolates from our organism collection were used as controls. SETTING: A 900-bed university hospital with a 22-bed CTSU. RESULTS: ChrDNA patterns of isolates from the two patients were identical, suggesting a possible nosocomial source. However, no source of organisms or mode of transmission was identified. Neither biotype nor antibiogram were useful for epidemiologically typing S odorifera, and PFGE was necessary to discriminate among isolates. CONCLUSIONS: Although rarely isolated, S odorifera and other non-marcescens Serratia species may cause nosocomial outbreaks. PFGE of chrDNA seems to be a reliable method for epidemiologically typing this species.

Aged↗