Spontaneous bacterial peritonitis causing Serratia marcescens and Proteus mirabilis ventriculoperitoneal shunt infection

Abstract

The authors report their experience treating a polymicrobial ventriculoperitoneal (VP) shunt infection in a developmentally delayed 21-year-old woman. Cerebrospinal fluid (CSF) cultures grew Serratia marcescens and Proteus mirabilis. On admission and throughout her hospitalization, results of physical examination of her abdomen were normal, and radiographic studies showed no evidence of bowel perforation or pseudocyst formation. Contrast-enhanced computed tomography of the abdomen revealed a small fluid collection. After a course of intravenous gentamicin and imipenem with cilastatin in conjunction with intrathecal gentamicin, the infection was resolved and the VP shunt was reimplanted. Although VP shunt infections are not uncommon, S. marcescens as a causative agent is exceedingly rare and potentially devastating. Only two previous cases of S. marcescens shunt infection have been reported in the literature. Authors reporting on S. marcescens infections in the central nervous system (CNS) have observed significant morbidity and death. Although more common, the presence of P. mirabilis in the CSF is still rare and highly suggestive of bowel perforation, which was absent in this patient. Spontaneous bacterial peritonitis was the likely source from which these bacteria gained entrance into the VP shunt system, eventually causing ventriculitis in this patient. The authors conclude that in light of the high morbidity associated with S. marcescens infection of the CNS, intrathecal administration of gentamicin should be strongly considered as part of first-line therapy for S. marcescens infections in VP shunts.

Quantitative detection of Proteus species by real-time polymerase chain reaction using SYBR Green I

“…Following Escherichia coli, Proteus is the second leading cause of Gram-negative bacterial urinary tract infections (Bauernfeind et al 1987;Liu et al 1992;Mobley and Belas 1995). Under certain circumstances, Proteus species can also cause other infections, such as bacteremia, respiratory infection, wound and burn infection, enteritis, pneumonia, chronic tympanitis, meningitis, peritonitis, keratitis, mastoiditis, and septicemia (Memmel et al 2004;Tumialan et al 2006;Bloch et al 2011). Because of the increasing clinical relevance of Proteus (O'Hara et al 2000), the development of efficient detection methods is of great epidemiological importance.…”