Serratia marcescens Necrotizing Fasciitis Presenting as Bilateral Breast Necrosis

Rehman, Tayyab; Moore, Thomas A.; Seoane, Leonardo

doi:10.1128/jcm.00843-12

Cited by 22 publications

(14 citation statements)

References 20 publications

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“…In this vein, it is most commonly recognised as a nosocomial infection especially in immunocompromised hosts and in the intensive treatment unit (ITU) setting. 3 However, it has been estimated that almost half of S. marcescens bacteraemias (47%) originate in a community setting. 3 We conducted a literature search for community acquired soft tissue infections caused by S. marcescens using Medline (search criteria: S. marcescens, soft tissue infection, cellulitis, necrotising fasciitis, limited to English language) and found 21 other reported cases, as shown in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…3 However, it has been estimated that almost half of S. marcescens bacteraemias (47%) originate in a community setting. 3 We conducted a literature search for community acquired soft tissue infections caused by S. marcescens using Medline (search criteria: S. marcescens, soft tissue infection, cellulitis, necrotising fasciitis, limited to English language) and found 21 other reported cases, as shown in Table 1. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In all but four cases the hosts were immunocompromised or had an infected wound source, and in three cases the risk factor for contracting S. marcescens was diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

“…1,12 Mortality from S. marcescens bacteraemia is high, with approximately one-third of patients dying within 6 months of diagnosis. 3 Early debridement is indicated and appropriate antibiotic and supportive care are the cornerstones of therapy in severe soft tissue infection due to S. marcescens. Early surgical review and escalation to ITU/HDU care is vital.…”

Section: Discussionmentioning

confidence: 99%

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Severe soft tissue infection in a patient with type 2 diabetes mellitus caused by Serratia marcescens as single pathogen

Biscoe

Hakeem²

2016

Br J Diabetes

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Serratia marcescens is a rare cause of soft tissue infection. However, it has been increasingly recognised as a pathogen causing infection in both immunocompromised patients and in patients in an intensive treatment unit setting. Here we describe an elderly patient with type 2 diabetes mellitus presenting with severe necrotic soft tissue infection due to S. marcescens acquired in the community. The literature on S. marcescens soft tissue infection is reviewed and management is discussed.Key words: S. marcescens, soft tissue infection, cellulitis, necrotising fasciitis, diabetes Case reportAn 80-year-old woman with a background of type 2 diabetes mellitus, heart failure, coronary artery bypass graft, atrial fibrillation, chronic renal failure, hypertension and breast cancer was admitted with a one-week history of worsening lower left limb pain, erythema and reduced mobility.She was initially stable on admission but rapidly deteriorated within an hour. She was febrile at 38 o C and her blood pressure dropped to 93/50 mmHg. She was tachycardic at 110 beats/min and tachypnoeic at 26 breaths/min with saturations of 94% on 28% oxygen. Capillary refill time was 4 seconds. Her left leg was erythematous, warm and tender with significant swelling and she had a number of bullae around the mid-thigh.Arterial blood gases showed hypoxia and a lactate of 5.1 mmol/L. Blood results showed acute on chronic renal failure (urea 14 mmol/L, creatinine 156 μmol/L), white cell count of 11.9 x10 9 /L with neutrophilia, platelet count of 77 x10 9 /L, C-reactive protein 309 mg/L and deranged coagulation with an International Ratio (INR) of 10 (the patient was on warfarin).An emergency CT scan demonstrated marked diffuse stranding within the fat subcutaneously and within muscle planes, particularly affecting the left flank but extending along the entire length of both legs. Multiple fluid-filled bullae were seen in the distal left leg (Figure 1). Sepsis 6 protocol was initiated and the patient was transferred to the high dependency unit (HDU) after commencing intravenous piperacillin-tazobactam and clindamycin for sepsis secondary to soft tissue infection, but she continued to deteriorate and remained hypotensive despite fluid resuscitation. She also developed haemorrhagic bullae extending to her thighs. Blood cultures were positive for gram-negative bacilli and piperacillin-tazobactam was therefore changed to meropenem.An urgent plastic surgical review recommended conservative non-surgical management due to her significant comorbidities.She continued to be managed on the HDU and her cellulitis

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Severe soft tissue infection in a patient with type 2 diabetes mellitus caused by Serratia marcescens as single pathogen

Biscoe

Hakeem²

2016

Br J Diabetes

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“…2,[4][5][6] Furthermore, there are increasing reports of antibiotic-resistant S. marcescens strains associated with nosocomial outbreaks. 2,[4][5][6] Furthermore, there are increasing reports of antibiotic-resistant S. marcescens strains associated with nosocomial outbreaks.…”

Section: Introductionmentioning

confidence: 99%

“…Infections caused by S. marcescens show various clinical manifestations, such as respiratory tract infection, urinary tract infection, bacteremia, endocarditis and wound infections, which can result in considerable morbidity and mortality. 2,[4][5][6] Furthermore, there are increasing reports of antibiotic-resistant S. marcescens strains associated with nosocomial outbreaks. 2,[7][8][9] Because of its well-known intrinsic resistance to many antimicrobial agents and the reported outbreaks of extremely resistant strains, such as extended-spectrum b-lactamase-producing and imipenem-resistant strains, S. marcescens has received considerable attention in various clinical settings.…”

Section: Introductionmentioning

confidence: 99%

Cutaneous Serratia marcescens infections in Korea: A retrospective analysis of 13 patients

Seo

Shin

et al. 2015

The Journal of Dermatology

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Serratia marcescens is a Gram-negative bacillus belonging to the Enterobacteriaceae family. Because of increasing reports of antimicrobial resistance, this bacterium has received considerable attention and has emerged as an important pathogen. In order to reveal clinical and microbiological characteristics of S. marcescens cutaneous infection and to suggest appropriate antibiotic treatment, we retrospectively analyzed 17 strains isolated from wound swabs of Korean patients between November 2005 and March 2014. A total of 13 patients (five men and eight women) were included in our study, with a mean age of 46.3 years (range, 21-82). Based on medical history, seven patients were classified as immunocompromised. Prior predisposing factors for infections were noted in 12 patients, including pre-existing leg ulcers or dermatitis (5/13), preceding cancer surgeries (2/13), plastic surgeries and filler injection (2/13), traumas (2/13) and medical procedures following cutaneous abscess (1/13). Cutaneous infections showed various clinical presentations, including spontaneous dermal abscess, fingernail change, painful nodules and papular erosions. We found that third- and fourth-generation cephalosporins, gentamicin, levofloxacin and meropenem appeared active against all 17 strains in vitro. Clinically, all patients treated with empirical first-generation cephalosporin showed treatment resistance, and oral quinolone monotherapy was the most preferred antibiotic regimen without treatment failure, with an average treatment duration of 25 days (range, 14-42). This study demonstrates the various clinical presentations and treatment responses for cutaneous S. marcescens infection. Moreover, we suggest that initial antibiotic coverage should be broad enough to account for multidrug resistance in this rare pathogen.

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Necrotizing fasciitis due to Serratia marcescens: case report and review of the literature

Majumdar

Crum-Cianflone

2015

Infection

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Serratia marcescens Necrotizing Fasciitis Presenting as Bilateral Breast Necrosis

Cited by 22 publications

References 20 publications

Severe soft tissue infection in a patient with type 2 diabetes mellitus caused by Serratia marcescens as single pathogen

Severe soft tissue infection in a patient with type 2 diabetes mellitus caused by Serratia marcescens as single pathogen

Cutaneous Serratia marcescens infections in Korea: A retrospective analysis of 13 patients

Necrotizing fasciitis due to Serratia marcescens: case report and review of the literature

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