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Snapshot
  • A 56-year-old man is admitted to the hospital for appendicitis. During the appendectomy, he had a foley inserted which was removed successfully post-operatively. A few days after the procedure, the patient started experiencing fevers, chills, and pain with urination. A urinalysis revealed increased white blood cells, red blood cells, and bacteria. A urine culture grew a catalase-positive, weakly lactose fermenting gram-negative bacilli.
Introduction
  • Classification
    • Serratia marcescens
      • a catalase-positive, weakly lactose fermenting, and gram-negative bacillus
      • produces prodigiosin, a pale pink or dark red pigment
    • clinical syndromes are often associated with recent instrumentation/procedure
      • urinary tract infection
      • wound infections
      • pneumonia
      • endocarditis
      • meningitis
  • Epidemiology
    • demographics
      • male > female
      • children > adults
    • risk factors
      • hospital admission
      • diabetes mellitus
      • kidney failure
      • chronic obstructive pulmonary disease
      • immunocompromised status
      • recent procedure at the site of infection
        • i.e., instrumentation of urinary tract or bronchoscopy
  • Pathogenesis
    • the bacteria colonizes the respiratory and urinary tracts and causes nosocomial infections
  • Prognosis
    • Serratia meningitis and endocarditis have the highest mortality
Presentation
  • Symptoms
    • fever and chills
    • shortness of breath
    • frequent urination
    • dysuria
  • Physical exam
    • suprapubic tenderness
Studies
  • Urine dipstick
    • nitrite positive
    • leukocyte esterase positive
  • Bacterial culture on EMB agar
    • lactose fermenters grow as purple or black colonies
  • Making the diagnosis
    • based on clinical presentation and laboratory studies
Differential
  • E. coli urinary tract infection
    • distinguishing factors
      • no red pigment
      • may not be associated with recent instrumentation
Treatment
  • Management approach
    • Serratia is resistant to many antibiotics, including first-generation cephalosporins
    • final choice of antibiotics depends on the sensitivities of cultured bacteria
  • Medical
    • 2nd generation or higher cephalosporins (cefoxitin, cefotaxime, and cefepime)
      • indication
        • all patients
    • fluoroquinolones   
      • indications
        • all patients
Complications
  • Septic shock
 

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