Bilateral endogenous <i>Serratia marcescens</i> endophthalmitis secondary to endocarditis following cardiac surgery

Lyall, Douglas; Gregory, Maria Elena; McDonnell, John; Villiers, Francois De; Tejwani, Deepak

doi:10.1177/0036933013482647

Cited by 13 publications

(4 citation statements)

References 29 publications

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“…21 In fact, only 19 cases of Serratia endocarditis have been reported in the English-language literature since 1980 (Table 1). 21-35 Similar to the case presented here, virtually all of these previously reported patients had chronic medical conditions or cardiovascular abnormalities, more than half had involvement of left-sided valves, and more than one fifth of the patients died. A few non-valvular endovascular Serratia infections have also been reported, and most of these cases were associated with preceding cardiac surgery and the presence of prosthetic material.…”

Section: Risk Factors and Epidemiologysupporting

confidence: 78%

Marvelous but Morbid

Phadke

Jacob

2016

Infectious Diseases in Clinical Practice

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A 46-year-old man with HIV infection and active intravenous drug use presented with approximately two weeks of fevers and body aches. On physical examination he was somnolent, had a new systolic murmur, bilateral conjunctival hemorrhages, diffuse petechiae, and left-sided arm weakness. Echocardiography revealed a large mitral valve vegetation and brain imaging demonstrated numerous embolic infarctions. Blood cultures grew Serratia marcescens. Despite aggressive treatment with meropenem the patient died due to intracranial hemorrhage complicated by herniation. Serratia marcescens is an uncommon cause of infective endocarditis. While this disease has historically been associated with intravenous drug use, more recent reports suggest that it is now largely a consequence of opportunistic infections of the chronically ill. Our case highlights several characteristic features of this infection, including isolation of a non-pigmented strain of the organism, an antibiotic susceptibility profile suggestive of AmpC β-lactamase production, and rapid clinical deterioration with multiple embolic complications resulting in death. In this review we discuss the history, epidemiology, and management of endovascular infections due to Serratia spp., emphasizing the continued importance of considering this organism in the differential diagnosis of endocarditis among intravenous drug users and as a potential indication for surgical therapy.

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Section: Risk Factors and Epidemiologysupporting

confidence: 78%

Marvelous but Morbid

Phadke

Jacob

2016

Infectious Diseases in Clinical Practice

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“…1 Only 15 cases were reported since 1994 (Table 1). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In nine cases, the risk factor for infection was IVDU; in the group of health-care-associated endocarditis only one had a prosthetic valve 8 and one pacemaker. 5 Similarly, most of the cases had either immunosuppressive or chronic disease.…”

Section: Discussionmentioning

confidence: 99%

Serratia marcescens Endocarditis: A Case Report and Literature Review

Ferreira¹,

Silva²,

Reis³

et al. 2022

Acta Med Port

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Serratia marcescens is a rarely implicated agent in endocarditis. We describe a case of a patient that underwent aortic and mitral valve replacement for Streptococcus agalactiae endocarditis. Four months later, he was readmitted with an ischemic stroke and fever. Physical examination and repetitive transthoracic echocardiogram were unremarkable. The initial blood cultures were negative. Due to sustained fever, vancomycin, gentamicin and piperacillin-tazobactam were initiated. On subsequent blood cultures, Serratia marcescens was isolated and antibiotics switched to ertapenem and gentamicin. In addition to cerebral emboli, a splenic embolus was found. The PET/CT revealed an abnormal hypercaptation in the mitral bioprosthesis. The patient was treated for six weeks. There are no current specific recommendations regarding the treatment of Serratia marcescens endocarditis. It is widely accepted that treatment should be prolonged and include a combination of antimicrobial agents. Morbidity and mortality are high, particularly when there’s the need for surgical replacement. In this case, however, the patient ended-up only requiring medical treatment due to the favourable response.

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“…Proper and timely diagnosis and treatment may be essential for maximizing outcomes, especially in cases of virulent organisms like S. marcescens that rapidly progress to involve all eye structures, though sample size and reports are limited. Serratia marcescens may progress before the ophthalmologist is consulted 15 . Thus, swift recognition and referral for signs of endophthalmitis could be favorable, especially in high-risk individuals with multiple co-morbidities.…”

Section: Discussionmentioning

confidence: 99%

Endogenous Serratia marcescens panophthalmitis: A case series

Breazzano

Jonna

Nathan

et al. 2019

American Journal of Ophthalmology Case Reports

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Purpose – Two rare and unusual cases of endogenous panophthalmitis from Serratia marcescens are presented with mechanisms for infection explored. Observations – The first patient had history of intravenous drug use (IVDU) without any medical implants. The second patient, in addition to IVDU, had a history of end-stage renal disease with upper extremity arteriovenous fistula graft infection from Serratia marcescens confirmed by wound culture. One patient had a history of licking the needles prior to IV drug injection. Clinical exam in both cases revealed light perception vision, relative afferent pupillary defect, periorbital edema with limited extraocular motility, and hypopyon in the affected eyes. Cultures from the anterior chamber aspirate were positive for Serratia marcescens in the first case and demonstrated Gram-negative rods in the second. Attempted vitreous aspiration was unsuccessful at obtaining specimens. Computed tomography demonstrated orbital fat stranding without abscess, and histopathology showed intense neutrophilic infiltration in all layers of enucleated specimen in case one. Conclusions and Importance Needle licking may be an underappreciated mechanism for endogenous endophthalmitis in intravenous drug users. This report includes the first case in the literature, to authors’ knowledge, of non-nosocomial endogenous Serratia marcescens panophthalmitis with orbital cellulitis. The second case illustrates a rare consequence of the rise in arteriovenous fistula placement and dialysis across the United States, which may predispose to future cases of endogenous Serratia marcescens endophthalmitis. This series supports previous observations of Serratia marcescens endogenous endophthalmitis exhibiting a generally poor visual prognosis.

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Bilateral endogenous Serratia marcescens endophthalmitis secondary to endocarditis following cardiac surgery

Abstract: The case highlights the importance of early recognition of the symptoms and signs of endogenous endophthalmitis in any patient with systemic infection by all clinicians and the necessity of prompt ophthalmological referral if a useful level of vision is to be preserved.

Cited by 13 publications

References 29 publications

Marvelous but Morbid

Marvelous but Morbid

Serratia marcescens Endocarditis: A Case Report and Literature Review

Endogenous Serratia marcescens panophthalmitis: A case series

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