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Serratia Bacteremia in a Large University Hospital: Trends in Antibiotic Resistance During 10 Years and Implications for Antibiotic Use

Published online by Cambridge University Press:  02 January 2015

Sang-Ho Choi ,
Yang Soo Kim ,
Jin-Won Chung ,
Tae Hyong Kim ,
Eun Ju Choo ,
Mi-Na Kim ,
Baek-Nam Kim ,
Nam Joong Kim ,
Jun Hee Woo  and
Jiso Ryu
Sang-Ho Choi
Affiliation:
Division of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Yang Soo Kim
Affiliation:
Division of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Jin-Won Chung
Affiliation:
Division of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Tae Hyong Kim
Affiliation:
Division of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Eun Ju Choo
Affiliation:
Division of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Mi-Na Kim
Affiliation:
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Baek-Nam Kim
Affiliation:
Division of Infectious Diseases, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
Nam Joong Kim
Affiliation:
Division of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Jun Hee Woo*
Affiliation:
Division of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Jiso Ryu
Affiliation:
Division of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
*
Division of Infectious Diseases, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, 138-736, Seoul, South Korea
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Abstract

Objective:

To identify antibiotic resistance trends and risk factors for resistance of Serratia species to third-generation cephalosporins.

Design:

Retrospective survey of medical records.

Setting:

A 2,200-bed, tertiary-care hospital.

Patients:

One hundred twenty-two patients with Serratia bacteremia between January 1991 and June 2001.

Methods:

Infectious disease physicians collected data from medical records regarding patient demographics, underlying disease or condition, portal of entry, microorganism, antibiogram, complications, antibiotics received, and outcome.

Results:

Among 122 Serratia isolates, 117 (95.9%) were Serratia marcescens and 110 (90.2%) were of nosocomial origin. During the study period, the 122 isolates showed a high rate of resistance to third-generation cephalosporins (45.9%) and extended-spectrum penicillins (56.6%). The resistance rate to ciprofloxacin was 32.0%. The resistance rate to third-generation cephalosporins increased from 31.7% for 1991 to 1995 to 54.9% for 1996 to 1998 and 50.0% for 1999 to 2001. In the multivariate analysis, prior use of a second-generation cephalosporin (adjusted odds ratio [OR], 5.90; 95% confidence interval [CI95], 1.41 to 24.6; P = .015) or a third-generation cephalosporin (OR, 3.26; CI95, 1.20 to 8.87; P = .020) was a strong independent risk factor for resistance to third-generation cephalosporins. The overall case-fatality rate was 25.4% (Serratia bacteremia-related case-fatality rate, 13.1%).

Conclusion:

Prior use of a second- or third-generation cephalosporin was the most important risk factor for bacteremia with Serratia resistant to third-generation cephalosporins, suggesting the need for antibiotic control. The potential role of patient-to-patient spread could not be fully evaluated in this retrospective study.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 12 , December 2002 , pp. 740 - 747
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Gatell, JM, Trilla, A, Latorre, X, et al. Nosocomial bacteremia in a large Spanish teaching hospital: analysis of factors influencing prognosis. Rev Infect Dis 1988;10:203–210.Google Scholar
2.Pfaller, MA, Jones, RN, Marshall, SAet al. Inducible amp C beta-lactamase producing gram-negative bacilli from blood stream infections: frequency, antimicrobial susceptibility, and molecular epidemiology in a national surveillance program (SCOPE). Diagn Microbiol Infect Dis 1997;28:211–219.Google Scholar
3.Edmond, MB, Wallace, SE, McClish, DK, Pfaller, MA, Jones, RN, Wenzel, RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999;29:239–244.Google Scholar
4.Richards, NM, Levitsky, S. Outbreaks of Serratia marcescens infections in a cardiothoracic surgical intensive care unit. Ann Thorac Surg 1975;19:503–513.Google Scholar
5.Geiseler, PJ, Harris, B, Andersen, BR. Nosocomial outbreak of nitrate-negative Serratia marcescens infections. J Clin Microbiol 1982;15:728–730.Google Scholar
6.Duggan, TG, Leng, RA, Hancock, BM, Cursons, RT. Serratia marcescens in a newborn unit: microbiological features. Pathology 1984;16:189–191.Google Scholar
7.Fry, DE, Fry, RV, Shlaes, DM. Serratial bacteremia in the surgical patient. Am Surg 1987;53:438–441.Google Scholar
8.Villarino, ME, Jarvis, WR, O'Hara, C, Bresnahan, J, Clark, N. Epidemic of Serratia marcescens bacteremia in a cardiac intensive care unit. J Clin Microbiol 1989;27:2433–2436.Google Scholar
9.Sokalski, SJ, Jewell, MA, Asmus-Shillington, , , AC, Mulcahy, J, Segreti, J. An outbreak of Serratia marcescens in 14 adult cardiac surgical patients associated with 12-lead electrocardiogram bulbs. Arch Intern Med 1992;152:841–844.Google Scholar
10.van Ogtrop, ML, van Zoeren-Grobben, D, Verbakel-Salomons, EM, van Boven, CP. Serratia marcescens infections in neonatal departments: description of an outbreak and review of the literature. J Hosp Infect 1997;36:95–103.Google Scholar
11.Harnett, SJ, Allen, KD, Macmillan, RR. Critical care unit outbreak of Serratia liquefaciens from contaminated pressure monitoring equipment. J Hosp Infect 2001;47:301–307.Google Scholar
12.Grohskopf, LA, Roth, VR, Feikin, DRet al. Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center. N Engl J Med 2001;344:1491–1497.CrossRefGoogle Scholar
13.Yu, VL. Serratia marcescens: historical perspective and clinical review. N Engl J Med 1979;300:887–893.Google Scholar
14.Eisenstein, BI, Zaleznik, DE. Enterobacteriaceae. In: Mandell, GL, Douglas, RG, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases, 5th ed. Philadelphia: Churchill Livingstone; 2000:2297–2310.Google Scholar
15.Livermore, DM. Clinical significance of β-lactamase induction and stable derepression in gram-negative rods. Eur J Clin Microbiol 1987;6:439–445.Google Scholar
16.Sanders, CC, Sanders, WE Jr. β-lactam resistance in gram-negative bacteria: global trends and clinical impact. Clin Infect Dis 1992;15:824–839.CrossRefGoogle ScholarPubMed
17.Bennett, PM, Chopra, I. Molecular basis of β-lactamase induction in bacteria. Antimicrob Agents Chemother 1993;37:153–158.Google Scholar
18.Dworzack, DL, Pugsley, MP, Sanders, CC, Horowitz, EA. Emergence of resistance in gram-negative bacteria during therapy with expanded-spectrum cephalosporins. Eur J Clin Microbiol 1987;6:456–459.Google Scholar
19.Dodson, WH. Serratia marcescens septicemia. Arch Intern Med 1968,121: 145–150.Google Scholar
20.Wilfert, JN, Barrett, FF, Kass, EH. Bacteremia due to Serratia marcescens. N Engl J Med 1968;279:286–289.Google Scholar
21.Henjyoji, EY, Whitson, TC, Ohashi, DK, Allen, BD. Bacteremia due to Serratia marcescens. J Trauma 1971;11:417–421.Google Scholar
22.Crowder, JG, Gilkey, GH, White, AC. Serratia marcescens bacteremia: clinical observations and studies of precipitin reactions. Arch Intern Med 1971;128:247–253.Google Scholar
23.Bouza, E, Garcia de la Torre, M, Erice, A, Cercenado, E, Loza, E, Rodriguez-Creixems, M. Serratia bacteremia. Diagn Microbiol Infect Dis 1987;7:237–247.Google Scholar
24.Sanchez Ruano, JJ, Garcia Díaz, JD, Alonso Navas, F. Serratia marcescens bacteremia: a report of 83 cases [in Spanish]. Medica Clinica 1988; 90:479–483.Google Scholar
25.Saito, H, Elting, L, Bodey, GP, Berkey, R. Serratia bacteremia: review of 118 cases. Rev Infect Dis 1989;11:912–920.CrossRefGoogle ScholarPubMed
26.Watanakunakorn, C. Serratia bacteremia: a review of 44 episodes. Scand J Infect Dis 1989;21:477–483.Google Scholar
27.Wong, WW, Wang, LS, Cheng, DL, et al. Serratia marcescens bacteremia. J Formos Med Assoc 1991;90:88–93.Google Scholar
28.Haddy, RI, Mann, BL, Nadkarni, DD, et al. Nosocomial infection in the community hospital: severe infection due to Serratia species. J Fam Pract 1996;42:273–277.Google Scholar
29.Yu, WL, Lin, CW, Wang, DY. Serratia marcescens bacteremia: clinical features and antimicrobial susceptibilities of the isolates. J Microbiol Immunol Infect 1998;31:171–179.Google Scholar
30.McCabe, WR, Jackson, GG. Gram-negative bacteremia: II. Clinical, laboratory, and therapeutic observations. Arch Intern Med 1962;110:856–864.Google Scholar
31.Chow, JW, Fine, MJ, Shlaes, DM, et al. Enterobacterbacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med 1991;115:585–590.Google Scholar
32.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing: Ninth Informational Supplement M100-S9. Wayne, PA: National Committee for Clinical Laboratory Standards; 1999.Google Scholar
33.Jones, RN. Important and emerging β-lactamase-mediated resistances in hospital-based pathogens: the Amp C enzymes. Diagn Microbiol Infect Dis 1998;31:461–466.Google Scholar
34.D'Agata, E, Venkataraman, L, DeGirolami, R, Weigel, L, Samore, M, Tenover, E. The molecular and clinical epidemiology of Enterobacteriaceae-producing extended-spectrum beta-lactamase in a tertiary care hospital. J Infect 1998;36:279–285.Google Scholar
35.De Champs, C, Rouby, D, Guelon, D, et al. A case-control study of an outbreak of infections caused by Klebsiella pneumoniae strains producing CTX-1 (TEM-3) beta-lactamase.J Hosp Infect 1991;18:5–13.Google Scholar
36.Jacoby, GA. Extended-spectrum beta-lactamases and other enzymes providing resistance to oxyimino-beta-lactamse. Incet Dis Clin North Am 1997;11:875–887.CrossRefGoogle Scholar
37.Kaye, KS, Fraimow, HS, Abrutyn, E. Pathogens resistant to antimicrobial agents: epidemiology, molecular mechanisms, and clinical management. Infect Dis Clin North Am 2000;14:293–319.Google Scholar
38.Meyer, KS, Urban, C, Eagan, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993;119:353–358.Google Scholar
39.Pena, C, Pujol, M, Ardanuy, C, et al. Epidemiology and successful control of a large outbreak due to Klebsiella pneumoniae producing extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1998;42:53–58.Google Scholar
40.Schiappa, DA, Hayden, MK, Matushek, MG, et al. Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli bloodstream infection: a case-control and molecular epidemiologic investigation. J Infect Dis 1996;174: 529–536.Google Scholar
41.Wiener, J, Quinn, JP, Bradford, PAet al. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517–523.Google Scholar
42.Livermore, DM. Beta-lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995;8:557–584.Google Scholar
43.Pitout, JD, Sanders, CC, Sanders, WE Jr. Antimicrobial resistance with focus on β-lactam resistance in gram-negative bacilli. Am J Med 1997; 103:51–59.Google Scholar
44.Jacobson, KL, Cohen, SH, Inciardi, JF, et al. The relationship between antecedent antibiotic use and resistance to extended-spectrum cephalosporins in group I β-lactamase-producing organisms. Clin Infect Dis 1995;21:1107–1113.Google Scholar
45.Sahm, DF, Storch, G. Amp C β-lactamases. Pediatr Infect Dis J 1998; 17:421–422.Google Scholar
46.Sanders, WE Jr, Sanders, CC. Inducible β-lactamases: clinical and epidemiologic implications for use of newer cephalosporins. Rev Infect Dis 1988;10:830–838.Google Scholar
47.Livermore, DM. Carbapenemases. J Antimicrob Chemother 1992;29:609–613.CrossRefGoogle ScholarPubMed
48.Naas, T, Vandel, L, Sougakoff, W, Livermore, DM, Nordmann, P. Cloning and sequence analysis of the gene for a carbapenem-hydrolyzing class A β-lactamase, Sme-1, from Serratia marcescens S6. Antimicrob Agents Chemother 1994;38:1262–1270.Google Scholar
49.Palomar, J, Puig, M, Montilla, R, Loren, JG, Vinas, M. Lipopolysaccharide recovery restores susceptibility levels towards β-lactamase in Serratia marcescens. Microbios 1995;82:21–26.Google Scholar
50.Cunha, BA. Antibiotic resistance. Med Clin North Am 2000;84:1407–1429.Google Scholar
51.Friedrich, LV, White, RL, Bosso, JA. Impact of use of multiple antimicrobials on changes in susceptibility of gram-negative aerobes. Clin Infed Dis 1999;28:1017–1024.Google Scholar
52.Kaye, KS, Cosgrove, S, Harris, A, Eliopoulos, GM, Carmeli, Y. Risk factors for emergence of resistance to broad-spectrum cephalosporins among Enterobader spp. Antimicrob Agents Chemother 2001;45:2628–2630.Google Scholar