Chorioamnionitis caused by Serratia marcescens in a non-immunocompromised host

Abstract

A 26 year old pregnant woman with antithrombin III deficiency developed recurrent septicaemia with Serratia marcescens. In spite of the administration of antibiotics, high grade fever persisted. She subsequently manifested lower abdominal pain, and spontaneous abortion occurred. After the abortion, she became completely afebrile. The amnion was turbid, and microscopic examination of the placenta showed haemorrhage and massive infiltration of neutrophils, suggestive of infectious chorioamnionitis. Pulsed field gel electrophoresis showed that isolates from the blood, urine, and vaginal discharge were genetically identical. Intravenous pyelography revealed that she had a bilateral completed double ureter. It was thought that a urinary tract anomaly caused infection with S marcescens, and the pathogen spread to the chorioamnion via the bloodstream. This is the first report of chorioamnionitis caused by S marcescens in a non-immunocompromised host. In addition, these findings indicate that the chorioamnion can serve as a site for persistent infection in normal pregnancies.

Late miscarriage caused bySerratia marcescens: a rare but dire disease in pregnancy

“…S. marcescens was reported as a cause of persistent chorioamnionitis and subsequent miscarriage in only three non-immunocompromised hosts 2 3. Our case is the fourth.…”

“…Serratia marcescens is the main species isolated in hospitals. This pathogen can be responsible for nosocomial infection, mostly in immunocompromised hosts, and s erratia septicaemia is a rare but dire disease in pregnancy 2 3…”

Prenatal sonography of placental abscess and prolonged antibiotic treatment for Serratia marcescens bacteremia

“…The optimal duration of antibiotics in treating S. marcescens bacteremia is unknown. Previous reports have suggested possible persistence of S. marcescens inside the chorioamnion and placental abscess after a short course(s) of antibiotics with a good initial response, resulting in recurrent bacteremia and miscarriage . Placental penetration of intravenous antibiotics might not be optimized .…”

“…The option of amniocentesis to exclude chorioamnionitis and for bacterial culture was discussed but was declined by the patient, who was concerned about its associated miscarriage risk. The patient was counseled and informed of the fact that Serratia chorioamnionitis was associated with a high risk of miscarriage and recurrent infections even with an apparent good initial response to antibiotics . The patient was decisive regarding continuation of her pregnancy.…”

“…Serratia bacteremia in pregnancy is a rare but potentially fatal disorder. Of six reported cases of S. marcescens ‐associated chorioamnionitis or placental abscess , four resulted in miscarriages and two in preterm deliveries before 29 weeks. Here, we report a case of placental abscess associated with S. marcescens bacteremia with subsequent delivery of an uninfected term baby after prolonged antibiotic therapy.…”