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Updated: Nov 27 2018


  • 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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