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The outbreak of Serratia marcescens bacteremia in a pediatric ward, Siriraj Hospital 1997.

Between October 20 and November 11, 1997, Serratia marcescens bacteremia was identified in 8 patients in a pediatric ward at Siriraj Hospital. The organism was isolated from 17 blood and 3 bone marrow specimens. The only common associated factor in these patients was that they all had received an intravenous fluid infusion. In the attempt to investigate the source of S. marcescens implicated in the outbreak, 108 specimens of intravenous fluid, 3 intravenous fluid bottle caps, 4 specimens from intravenous fluid tubing sets, 21 specimens of antiseptics used on the ward, 28 specimens of rectal swabs from patients on the ward, 1 sample of blood culture media prepared by the hospital for routine use, and 62 environmental specimens including hand swabs of the medical personnel, refrigerator, air conditioning, milk samples, room air, water sink, wooden splint and adhesive tape used to immobilize the intravenous access. Of 227 specimens sent for culture, S. marcescens was isolated from only one specimen collected from the in-use intravenous fluid given to a patient with Serratia bacteremia. S. marcescens was not found in any other surveillance culture. The 8 patients were placed under quarantine in the same room with an exclusive nursing team. With the investigation and intervention including monitoring for meticulous hand washing of the ward staff, the outbreak was stopped within 7 days. Although the investigation failed to discover the environmental reservoir of S. marcescens in this outbreak, the data suggested that intravenous fluid was probably the route of transmission and the medical personnel played an important role in spreading the infection.

Anti-Bacterial Agents↗

An outbreak of Serratia marcescens in 14 adult cardiac surgical patients associated with 12-lead electrocardiogram bulbs.

Two clusters of Serratia marcescens in 14 adult cardiac surgical patients occurred over 10 months in an 876-bed teaching hospital. The 14 infections that were studied were as follows: one sternal and five leg incisions, five pneumonias, one bacteremia, one urinary tract infection, and one infected internal defibrillator site. The first cluster included four pneumonias, one urinary tract infection, and one bacteremia. Corrective actions were taken based on outbreak data through no source was identified. No further infections occurred during the following 2 months. The second cluster included one sternal and five leg incisions, an infected internal defibrillator incision site, and one pneumonia. Serratia marcescens was isolated from six electrocardiogram rubber welsh bulbs with sensitivities identical to patient isolates that indicated a common source outbreak in at least the second cluster of infections. Disposable electrocardiogram leads were introduced and the problem was resolved. We conclude that reusable electrocardiogram welsh bulbs are a vector for postoperative infections.

Aged↗

Microbiologic investigation of an epizootic of mastitis caused by Serratia marcescens in a dairy herd.

An epizootic of subclinical and clinical mastitis caused by Serratia marcescens was investigated in a 1,000-cow dairy farm in California. Serratia marcescens was isolated from 13 to 18% of composite milk samples obtained from lactating dairy cows. During monthly milk sampling performed during a 4-month period, S marcescens was isolated from 38.8 to 62.3% of composite milk samples obtained from cows from which S marcescens was previously isolated. Few cows infected with S marcescens had evidence of clinical mastitis. Somatic cell count value was associated with isolation of S marcescens. Cows with somatic cell counts greater than 500,000 were 5.48 times as likely to have intramammary infections with S marcescens, compared with cows with somatic cell count less than or equal to 500,000. Lactation number also was associated with S marcescens intramammary infection. After adjusting for the effect of lactation number, cows with high somatic cell count values were 2.98 times as likely to have intramammary infection with S marcescens, compared with cows with low somatic cell counts. Infection with S marcescens was independent of days in lactation, production string, and daily milk production. Eleven months after the beginning of the epizootic, S marcescens was isolated from organic bedding samples obtained from the dairy. Despite numerous attempts, other sources of S marcescens could not be identified on this dairy.

Animals↗

Serratia marcescens bacteremia at a medical center in southern Taiwan: high prevalence of cefotaxime resistance.

Antimicrobial resistance of isolates and risk factors for mortality were retrospectively investigated in 71 adult patients with Serratia marcescens bacteremia. During the 4-year study period, 78 clinically significant episodes of S. marcescens bacteremia occurred in 71 patients. The mean age of the patients was 65 years (range, 25-86 years) with a male predominance (45 patients, 63%). Most of the bacteremic episodes were nosocomial (78%), and 34% were polymicrobial. The overall mortality rate within 2 weeks after the onset of bacteremia was 41%. The presence of malignancy and critical illness at initial presentation were independent risk factors for mortality. By disk susceptibility test, 72 isolates were resistant to cefotaxime (92%) but susceptible to ceftazidime (99%). All isolates were susceptible to meropenem. Among the 47 patients with monomicrobial S. marcescens bacteremia, the mortality rate within 5 days of onset in patients receiving appropriate empirical antimicrobial therapy was lower than that in patients receiving inappropriate therapy although this difference was not significant (14% vs 28%, p = 0.27). Among the patients with cefotaxime-resistant but ceftazidime-susceptible S. marcescens bacteremia treated with ceftazidime, 6 of 7 patients (86%) survived for more than 2 weeks, suggesting the potential effectiveness of ceftazidime in the treatment of cefotaxime-resistant Serratia infections. Further clinical studies are required to delineate the clinical role of ceftazidime therapy for infections caused by S. marcescens with this resistant phenotype.

Adult↗

Fatal delayed transfusion reaction in a sickle cell anemia patient with Serratia marcescens sepsis.

Patients with sickle cell anemia may require repeated red cell transfusion, putting them at risk for minor blood group alloimmunization and the development of delayed hemolytic transfusion reactions. Although Streptococcus pneumoniae is the most common cause of life-threatening infection in patients with sickle cell anemia, those who have been recently hospitalized are at risk for infection with resistant hospital-associated organisms, and blood transfusion may put the patient at risk of infection with transfusion-associated organisms such as Serratia marcescens and Yersinic enterocolitica. We recently cared for an adolescent with sickle cell anemia who presented to the emergency department with a severe, delayed hemolytic transfusion reaction and Serratia marcescens infection. The patient had been discharged from the hospital five days previously, and had been transfused and treated with antibiotics while hospitalized. In addition to demonstrating the potential severity of delayed hemolytic transfusion reactions, our case illustrates the importance of providing relatively broad-spectrum antibiotic coverage to patients with sickle cell anemia and possible infection who have recently been hospitalized.

Adolescent↗

Serratia marcescens peritonitis in a patient receiving chronic ambulatory peritoneal dialysis complicated by osteomyelitis.

Peritonitis, a common complication of chronic ambulatory peritoneal dialysis (CAPD), arises from various bacterial pathogens. We report the case of a patient with CAPD-associated peritonitis caused by Serratia marcescens. This case was further complicated by the development of osteomyelitis believed to have occurred from hematogenous seeding of Serratia marcescens.

Adult↗

Serratia marcescens as a cause of postoperative infection in a total joint implant.

Serratia marcescens is a rare cause of musculoskeletal infections and osteomyelitis occurring most frequently in nosocomial infections, debilitated patients, drug addicts, and traumatic open wounds. It is rarely a cause of postoperative infection in elective surgery with only a few such cases being reported in the United States and European literature. The authors present a case of Serratia marcescens infection of a total joint implant from an apparent perioperative source and review the literature concerning this organism as a cause of infection in man.

Cefotetan↗

Identification of Serratia marcescens on the basis of polymerase chain reaction-amplified ribosomal DNA spacer polymorphisms.

The aim of the present study was to develop a method for identification of strains of Serratia marcescens that is also suitable for use in the epidemiologic studies. 40 clinical strains of Serratia marcescens were investigated by using the polymerase chain reaction (PCR). We used primers to amplify spacer regions between the 16S and 23S genes in the prokaryotic rDNA genetic loci. When the spacer amplification products were resolved by electrophoresis, the resulting patterns could be used to distinguish all of the strains tested into 3 groups (group A-35, group B-3 and group C-2 isolates). Digestion of PCR fragments of the group A strains with HinfI enzyme enabled separation of organisms into 3 distinct groups (A1-A3).

Base Sequence↗

Fatal meningitis due to Serratia marcescens after stapedectomy.

Meningitis and septicemia due to Serratia marcescens developed in a patient postoperatively after stapedectomy. The infection with this organism is rare but has to be considered in differential diagnosis of bacterial meningitis because the early treatment with intrathecal administration of antibiotics may be lifesaving. Most of the reported cases of meningitis due to Serratia were due to S marcescens.

Humans↗

Bleaching of Serratia marcescens by some coumarins: a spectrophotometric study.

Recently, we reported that umbelliprenin inhibits the red pigment production in Serratia marcescens . In this current investigation the bleaching effect of the umbelliprenin was further studied using the spectrophotometric method, and its IC 50 was calculated. Also in this study the effect of the other coumarins extracted from Ferula persica roots were evaluated for depigmentation of Serratia marcescens . None of these compounds appeared to have a bleaching effect against a test strain at certain concentrations. Comparing the structures of the different coumarins showed that the linear sesquiterpene part of the umbelliprenin structure may be essential for the bleaching effect of S. marcescens .

Anti-Bacterial Agents↗

The extracellular nuclease of Serratia marcescens: studies on the activity in vitro and effect on transforming DNA in a groundwater aquifer microcosm.

A quantitative endonuclease assay, which relies on the introduction of single and double strand breaks into supercoiled plasmid DNA, was used to study the activity of the extracellular nuclease of Serratia marcescens SM6 in buffer and in groundwater. The parallel enzyme concentration-dependent production of relaxed and linear plasmid molecules suggests that the nuclease produces single and double strand breaks in duplex DNA. Bovine serum albumin stimulated the nuclease activity towards DNA and RNA and increased the stability of the enzyme against thermal inactivation. The DNase activity at 4 degrees C and 50 degrees C was almost half of that at the optimum temperature (37 degrees C). The nuclease was active in groundwater, although the specific activity was lower than in buffer. In a groundwater aquifer microcosm, mineral-adsorbed transforming DNA was substantially less accessible to the nuclease than was dissolved DNA. The data suggest that the extracellular nuclease of Serratia marcescens may contribute to DNA turnover in the environment and that adsorption of DNA to minerals provides protection against the nuclease.

Chromosomes, Bacterial↗

[The influence of the antivitamine pyrithiamine on the metabolism of the thiamin-autotrophic Serratia marcescens].

A new method is described for the quantitative microbiological analysis of the thiamine analog pyrithiamine present in biological material. The method uses a mutant of Lactobacillus fermenti (ATCC 9338) stimulated by pyrithiamine. By this specific method it is found that Serratia marcescens is able to consume and to phosphorylate the antivitamine (presumably to pyrithiamine monophosphate). The uptake of the analog influences neither the generation time of Serratia marcescens nor the biomass of the culture, nor the total amounts of carbohydrate and protein within the cells. On the contrary, pyrithiamin stimulates the exponential death-rate k and decreases the quantity of neutral fats. The carbon source glycerol is consumed at a higher rate, which is paralleled by an increased total amount of pyruvate as well as by an increased biosynthesis of acetoin.

Acetoin↗

Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens.

In conjugational crosses, three Klebsiella pneumoniae strains and one Serratia marcescens strain have been demonstrated to transfer resistance determinants to newer types of cephalosporins. While Klebsiella strains donated cefotaxime, cefamandole and cefuroxime resistance to Escherichia coli K-12 recipients, the genetic analysis of exconjugants after the transfer of plasmids from Serratia strains to Proteus or Salmonella recipients showed that the cefoxitin resistance determinant was also co-transferred. In subsequent transfer cycles of this plasmid, cefotaxime and cefoxitin resistance determinants segregated in contrast to the relative stability of plasmids derived from Klebsiella strains in subsequent transfer cycles. From results obtained in this study, it may be concluded that in some strains of nosocomial Enterobacteriaceae, resistance to newer cephalosporins could be transmissible and thus plasmid-located.

Cefamandole↗

Assay of extracellular proteinases using a colorimetric collagen substrate for the differentiation of Serratia in the tribe Klebsielleae.

The gelatin test has been utilized for many years as a characteristic to separate the genus Serratia from other members of the tribe Klebsielleae. Gelatin is a large protein matrix that cannot diffuse into bacterial cells. Microbes that attack gelatin do so by producing extracellular proteinases. The measurement of gelatinase has suffered from the lack of a definable endpoint and the inability to quantitate the enzyme. A method was developed utilizing an azo-dye-labelled collagen substrate that could measure the extracellular proteinase of serratia. The test was easy to perform, inexpensive, and potentially quantifiable. The azo-dye test corresponded completely with the gelatinase tests.

Collagen↗

Exocellular proteases of Serratia marcescens and their toxicity to larvae of Galleria mellonella.

Out of 18 strains of Serratia marcescens producing exocellular proteases the strain Serratia marcescens CCEB 415 was selected according to preliminary experiments. It could be shown that the train exhibits proteolytic activity reaching up to 10 TU per 1 ml of the culture filtrate in a medium with gelatine and peptone. Two proteolytic enzyme could be demonstrated by means of specific inhibitors EDTA and diisopropyfluorophosphate: metalprotease with optimum activity at pH 7.5 and serine protease with pH optimum of 10.9. The enzymes were purified on Sephadex and DEAE cellulose columns and by means of gel electrophoresis. However, it was not possible to separate them. The optimum temperature for activity of the mixture of the two enzymes was 50degrees C, molecular weight varied around 37000 (according to gel filtration); certain kinetic characteristics of their activity were determined. Excess subtrate (casein) inhibited activity of the enzyme mixture. Toxicity of proteases expressed as LD50 units equals 78 - 10(3) TU per larva of Galleria mellonella.

Animals↗

Purification and properties of a novel insecticidal protein from the locust pathogen Serratia marcescens HR-3.

One or more proteinaceous factors with insecticidal activities in the locust pathogen Serratia marcescens HR-3 culture filtrates were found to cause the death of grassland locusts. A novel insecticidal protein was purified to homogeneity. It was a monomer of 61 kDa. The purified protein showed a strong insecticidal effect with a median lethal dosage of 12.1 microg locust(-1) and contained a high level of protease activity (101 U ml(-1)). Insecticidal activity was significantly decreased when the protein was pretreated with ethylene diamine tetraacetic acid and 1-10-phenanthroline, and it was restored when the treated protein was incubated with Zn(2+). The N-terminal amino acid sequence of insecticidal protein showed sequence similarity with metalloprotease from S. marcescens SM6 and Serratia spp. E15. Our results suggested that the factor primarily responsible for insecticidal activity toward locusts was a zinc-dependent 61-kDa metalloprotease.

Amino Acid Sequence↗

Characterization of porins isolated from the outer membrane of Serratia liquefaciens.

A major outer membrane protein with an apparent molecular weight of 42 kDa was purified from Serratia liquefaciens grown on Brain Heart Infusion medium. The same protein was obtained when the cells were grown on a synthetic medium supplemented with 2% glucose. The amino acid composition of this protein revealed it to be hydrophilic. The pore-forming ability of the 42-kDa protein was determined by the liposome swelling assay. This assay demonstrated that the protein forms nonspecific channels with a diameter between 1.16 and 1.6 nm. An additional protein with a molecular weight of 47 kDa was obtained on synthetic medium supplemented with maltose. This protein exhibited specific pore-forming ability to maltose and maltodextrins, but was also permeable to other compounds, according to their size. When bacteria were grown on Nutrient Broth medium, two outer membrane proteins with molecular weights of 41 kDa and 42 kDa were produced by the bacteria. All three types of proteins represent monomers of respective oligomers. The monomers did not exhibit pore-forming ability when incorporated into liposomes. We, therefore, propose that the oligomer is the functional unit of a porin capable of forming permeability channels in the outer membrane of Serratia liquefaciens. These results indicate that S. liquefaciens contains several porins exhibiting specific osmoregulation or that are induced by a specific nutrient, where the 42-kDa outer membrane protein of this bacterium is certainly a major porin.

Amino Acids↗

Disruption of the copper efflux pump (CopA) of Serratia marcescens ATCC 274 pleiotropically affects copper sensitivity and production of the tripyrrole secondary metabolite, prodigiosin.

The prodigiosin biosynthetic gene cluster (pig cluster) of Serratia marcescens ATCC 274 (Sma 274) is flanked by cueR/copA homologues. Inactivation of the copA homologue resulted in an increased sensitivity to copper, confirming that CopA is involved in copper homeostasis in Sma 274. The effect of copper on the biosynthesis of prodigiosin in Sma 274 and the copA mutant strain was investigated. Increased levels of copper were found to reduce prodigiosin production in the wild type Sma 274, but increase production in the copA mutant strain. The physiological implications for CopA mediated prodigiosin production are discussed. We also demonstrate that the gene products of pigB-pigE of Sma 274 are sufficient for the biosynthesis of 2-methyl-3-n-amyl-pyrrole and condensation with 4-methoxy-2,2'-bipyrrole-5-carboxyaldehyde to form prodigiosin, as we have shown for Serratia sp. ATCC 39006.

Bacterial Proteins↗