Clinical and Microbiological Survey of Serratia marcescens Infection During HIV Disease

Abstract

Clinical charts of 2,398 consecutive HIV-infected patients hospitalized over an 8-year period were reviewed retrospectively to identify all cases of Serratia infection and to evaluate the occurrence and outcome of these cases according to several epidemiological. clinical, and laboratory parameters. Seventeen of 2,398 (0.71%) patients developed Serratia marcescens infections: nine had septicaemia, six had pneumonia, one had a lymph node abscess, and one had cellulitis. All patients were severely immunocompromised, as evidenced by a mean CD4+ lymphocyte count of < 70 cells/microl and a frequent diagnosis of AIDS (13 patients). When compared with other disease localizations, septicaemia was related to a significantly lower CD4+ cell count and a more frequent occurrence of neutropaenia. Antibiotic, corticosteroid, or cotrimoxazole treatment was frequently carried out during the month preceding disease onset. Hospital-acquired Serratia spp. infection was more frequent than community-acquired infection and was significantly related to AIDS, neutropaenia, and sepsis. Antimicrobial sensitivity testing showed complete resistance to ampicillin and cephalothin but elevated susceptibility to ureidopenicillins, second- and third-generation cephalosporins, aminoglycosides, quinolones, and cotrimoxazole. An appropriate antimicrobial treatment attained clinical and microbiological cure in all cases, in absence of related mortality or relapses. Since only 13 episodes of HIV-associated Serratia spp. infection have been described until now in nine different reports (7 patients with pneumonia, 3 with sepsis, 1 with endophthalmitis, 1 with perifolliculitis, and 1 with cholecystitis), our series represents the largest one dealing with Serratia marcescens infection during HIV disease. Serratia marcescens may be responsible for appreciable morbidity among patients with HIV disease, especially when a low CD4 + cell count, neutropaenia, and hospitalization are present. The clinician and the microbiologist facing a severely immunocompromised HIV-infected patient with a suspected bacterial disease should consider the Serratia spp. organisms. In fact, a rapid diagnosis and an adequate and timely treatment can avoid disease relapses and mortality.

Novel Tetracycline Resistance Determinant Isolated from an Environmental Strain of Serratia marcescens

“…S. marcescens infections (septicemia, pneumonia, cellulitis) are also problematic in human immunodeficiency virus-infected persons (24). S. marcescens is ubiquitous in nature and can be found in water, soil, plants, insects, and animals (1).…”

Characterization of a Cytotoxic Factor in Culture Filtrates of Serratia marcescens

“…Finally, recombinant expression of the S. marcescens 56-kDa metalloprotease conferred a cytotoxic phenotype on the culture filtrates of a nonpathogenic Escherichia coli strain. Collectively, these data suggest that the 56-kDa metalloprotease contributes significantly to the in vitro cytotoxic activity commonly observed in S. marcescens culture filtrates.Serratia marcescens is a gram-negative enteric bacterium that can function as an opportunistic pathogen within immunocompromised hosts (7,14,23,24,41). S. marcescens is a source of nosocomial infections, in part because the organism readily adheres to invasive hospital instrumentation, such as catheters, endoscopes, and intravenous tubing (1,17,27,32,34), and is relatively resistant to standard sterilization and disinfection protocols (3,8,52,53).…”

Serratia marcescensendogenous endophthalmitis in an immunocompetent host

“…It can also cause conjunctivitis and keratitis, and systemically it can cause meningitis, otitis media, endocarditis, pneumonitis and septicaemia. It is generally sensitive to quinolones, aminoglycosides and third-generation cephalosporins, although resistance to the latter has been reported 1 3 4. Serratia endophthalmitis, endogenous or otherwise, is associated with poor visual prognosis 5.…”