A Fatal Case of Infective Endocarditis Caused by an Unusual Suspect: <i>Serratia marcescens</i>

Abstract

Serratia marcescens has been reported to cause infective endocarditis among intravenous drug users, but it is extremely rare in non-intravenous drug users in Japan. In this article, we report an 85-year-old woman with diabetes mellitus who presented with low-grade fever and general fatigue. She was administered intravenous prednisolone under a diagnosis of right Bell's palsy before this admission. Blood cultures revealed positive Serratia marcescens, which was complicated by multiple cerebral infarctions after admission. Transthoracic echocardiography on day 5 revealed vegetation on the mitral valve, which was diagnosed as infective endocarditis. An operation could not be performed because of the presence of multiple cerebral infarctions. She died on day 65 because of uncontrolled heart failure.

Serratia marcescens Tricuspid Valve Vegetation and Successful Use of the AngioVac® System

“…The organism is frequently a hospital-acquired bacterium and is known to cause infections such as catheter-associated urinary tract infections, pneumonia, meningitis, and wound infections [ 8 - 9 ]. The first case of S. marcescens IE was reported in 1951 and had an association with IVDU [ 8 , 10 ]. Virulence factors of this organism include lipopolysaccharide, pore-forming hemolysin, mannose-resistant pilli, mannose-sensitive pili, chitinase, lipase, chloroperoxidase, and biofilm production [ 8 - 10 ].…”

“…The first case of S. marcescens IE was reported in 1951 and had an association with IVDU [ 8 , 10 ]. Virulence factors of this organism include lipopolysaccharide, pore-forming hemolysin, mannose-resistant pilli, mannose-sensitive pili, chitinase, lipase, chloroperoxidase, and biofilm production [ 8 - 10 ]. Serratia , along with some other Eneterobacteriacae , have an AmpC Beta-lactamase that is able to hydrolyze penicillin as well as first, second, and third-generation cephalosporins.…”

Serratia marcescens Endocarditis with Perivalvular Abscess Presenting as Atrioventricular Block

“…In fact, mortality is noted to be as high as 85% in patients with S. marcescens endocarditis who only received medical therapy. Treatment with only medical therapy has been more successful in those diagnosed with right-side endocarditis [3]. e 2005 Infectious Diseases Society of America (IDSA) and 2009 European Society of Cardiology make no specific recommendations on antimicrobial therapy but suggest the use of a combination of a beta-lactam and an aminoglycoside for at least 6 weeks of treatment.…”

“…S. marcescens is most commonly known to cause urinary tract infections, pneumonia, and soft tissue infections. Infective endocarditis by S. marcescens, first described in 1951, is extremely rare accounting for only 0.14% of all cases of endocarditis [2][3][4].…”

Abstracts

“…Serratia endocarditis is commonly left sided even in IVDU. 18 Forty percent of Serratia marcescens endocarditis are on aortic valve and septic embolization is very common. 19 Mortality rates are high with just medical therapy 19 , so a combination of medical and surgical management is recommended for left sided endocarditis by Serratia.…”