eMedicine Specialties > Infectious Diseases > Bacterial Infections

Serratia

Author: Basilio J Anía, MD, Consultant in Internal Medicine, Associate Professor of Infectious Diseases, Department of Internal Medicine, Division of Infectious Diseases, Hospital Negrín & Universidad de Las Palmas de Gran Canaria, Spain
Contributor Information and Disclosures

Updated: Nov 4, 2009

Introduction

Background

Serratia species are opportunistic gram-negative bacteria classified in the tribe Klebsielleae and the large family Enterobacteriaceae.

Serratia marcescens is the primary pathogenic species of Serratia. Rare reports have described disease resulting from infection with Serratia plymuthica,1 Serratia liquefaciens,2 Serratia rubidaea,3 Serratia odorifera, and Serratia fonticola.53

Some strains of S marcescens are capable of producing a pigment called prodigiosin, which ranges in color from dark red to pale pink, depending on the age of the colonies. S marcescens has a predilection for growth on starchy foodstuffs, where the pigmented colonies are easily mistaken for drops of blood.

In 1819, Bartolomeo Bizio, a pharmacist from Padua, Italy, discovered and named S marcescens when he identified the bacterium as the cause of a miraculous bloody discoloration in a cornmeal mush called polenta. Bizio named Serratia in honor of an Italian physicist named Serrati, who invented the steamboat, and Bizio chose marcescens (from the Latin word for decaying) because the bloody pigment was found to deteriorate quickly.4

Since 1906, physicians have used S marcescens as a biological marker for studying the transmission of microorganisms because, until the 1950s, this bacterium was generally considered a harmless saprophyte. Only since the 1960s has S marcescens been recognized as an opportunistic pathogen in humans.5

Pathophysiology

In the hospital, Serratia species tend to colonize the respiratory and urinary tracts, rather than the gastrointestinal tract, in adults.

Serratia infection is responsible for about 2% of nosocomial infections of the bloodstream, lower respiratory tract, urinary tract, surgical wounds, and skin and soft tissues in adult patients. Outbreaks of S marcescens meningitis, wound infections, and arthritis have occurred in pediatric wards.

Serratia infection has caused endocarditis and osteomyelitis in people addicted to heroin.

Cases of Serratia arthritis have been reported in outpatients receiving intra-articular injections.

Frequency

United States

Serratia species are responsible for 1.4% of nosocomial bloodstream infections.

International

  • The yearly incidence of Serratia bacteremia is 1.03 per 100,000 population, with 47% of episodes having their onset in the community.52
  • The prevalence of Serratia species as a cause of nosocomial infections is diminishing, but these bacteria are still able to cause hospital outbreaks, especially in intensive care units.

Mortality/Morbidity

  • In a population-based study of Serratia bacteremia, the 7-day and 6-month mortality rates were 5% and 37%, respectively.52
  • Serratia meningitis and Serratia endocarditis carry a high mortality rate.

Sex

Most (68%) episodes of Serratia bacteremia occur in males.52

Age

Outbreaks of Serratia infection occur in neonates and infants. In adults, most Serratia infections are isolated, but occasional nosocomial outbreaks occur.

Clinical

History

  • Sepsis: Patients with Serratia sepsis may present with fever, chills, shock, and respiratory distress.
  • Urinary tract infection
    • Approximately 30-50% of patients with Serratia urinary tract infections are asymptomatic. Symptoms may include fever, frequent urination, dysuria, pyuria, or pain upon urination.
    • In 90% of cases, patients have a history of recent surgery or instrumentation of the urinary tract.
    • Important risk factors for with Serratia urinary tract infections include diabetes mellitus, urinary tract obstruction, and renal failure.
  • Respiratory tract infection
    • Patients with Serratia respiratory tract infection are usually are colonized with Serratia species after instrumentation (eg, ventilation, bronchoscopy), especially those with chronic obstructive pulmonary disease.
    • Serratia pneumonia may develop, but this is rare. Patients with pneumonia may have fever, chills, productive cough (sometimes with pseudohemoptysis6 ), hypotension, dyspnea, and/or chest pain.
  • Meningitis or cerebral abscess
    • Serratia meningitis or cerebral abscesses may develop in premature children and neonates with prior sepsis. Patients who have experienced head trauma or have undergone neurosurgery, lumbar puncture, or even epidural injections are at risk of developing meningitis or cerebral abscess.
    • The symptoms are those of gram-negative meningitis (eg, headache, fever, vomiting, stupor, coma).
  • Intra-abdominal infections: Patients with Serratia intra-abdominal infections may present with biliary drainage, hepatic abscess, pancreatic abscess, and peritoneal exudate. Serratia peritonitis can complicate peritoneal dialysis.7
  • Osteomyelitis and arthritis: Serratia osteomyelitis and arthritis may develop following hematogenous spread in persons who are addicted to intravenous drugs or may be caused exogenously by surgery, open trauma, or intra-articular injection. S marcescens osteomyelitis is a common presentation of chronic granulomatous disease in infancy.51
  • Endocarditis: Patients with Serratia endocarditis may present with fever, petechiae, and, occasionally, embolic complications (eg, stroke, arterial emboli).
  • Ocular infections: Patients with Serratia ocular infections present with keratitis or endophthalmitis.
  • Soft-tissue infections: Patients with Serratia soft-tissue infections may have surgical scars, cellulitis, phlebitis, or skin infections.
  • Otitis media: Patients with Serratia otitis media present with earaches, hearing loss, and ear discharge.
  • Parotitis: Serratia parotitis is rare.

Physical

  • Pink hypopyon in the absence of hyphema may suggest S marcescens endophthalmitis.8

Causes

  • Sepsis or bacteremia
    • The main risk factor for Serratia sepsis/bacteremia is hospitalization. Placement of intravenous, intraperitoneal, or urinary catheters and prior instrumentation of the respiratory tract have been identified as risk factors among inpatients.
    • Other risk factors include cardiac valve replacement, transfusions, and the use of contaminated intravenous infusions. An outbreak of bacteremia was caused by pooling the residual contents of preservative-free epoetin vials for later use. Another outbreak was traced to tampering with an infused narcotic by a hospital employee.9 A multistate outbreak of S marcescens bloodstream infection was linked to contaminated intravenous magnesium sulfate distributed in the United States by a compounding pharmacy.10
    • Contamination of a faucet resulted in 2 cases of bacteremia during an outbreak of 10 S marcescens infections in an intensive care unit.11
  • Urinary tract infection
    • Ninety percent of patients with Serratia urinary tract infection have a history of recent surgery or instrumentation of the urinary tract.
    • Important risk factors include diabetes mellitus, urinary tract obstruction, and renal failure.
  • Respiratory tract infection: Serratia respiratory tract infection may develop after instrumentation (eg, ventilation, bronchoscopy), especially in patients with chronic obstructive pulmonary disease. During an outbreak of S marcescens infections traced to a contaminated faucet (including consumption of tap water from the faucet) in an intensive care unit, 9 patients developed respiratory tract infection (8 developed septic bronchitis; 1 developed empyema), while another 9 patients developed only S marcescens colonization of the respiratory tract.11
  • Meningitis and cerebral abscess: Serratia meningitis or cerebral abscess may develop in premature children and neonates with prior sepsis. Serratia meningitis may also develop in adults who have experienced head trauma or have undergone neurosurgery, epidural injection, or lumbar puncture.
  • Osteomyelitis and arthritis: Osteomyelitis or arthritis can be hematogenous in people addicted to intravenous drugs, or can be caused exogenously by surgery, open trauma, or intraarticular injection.
  • Ocular infections
    • Serratia infection frequently causes nonulcerating bacterial keratitis, which is associated with wearing soft and rigid contact lenses.
    • Serratia endophthalmitis usually occurs after eye surgery.
  • Parotitis: Bacterial parotitis may develop in individuals with prior sialectasia.
  • Cutaneous infections: Poorly healing skin ulcers in combination with S marcescens infections at multiple sites are typical in young adults with chronic granulomatous disease.51 Dermal abscesses and skin ulcers in the legs have appeared after a toe-web infection.12

More on Serratia

Overview: Serratia
Differential Diagnoses & Workup: Serratia
Treatment & Medication: Serratia
Follow-up: Serratia
References
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Further Reading

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Keywords

Serratia infection , Serratia marcescens, S marcescens, Serratia plymuthica, S plymuthica, Serratia liquefaciens, S liquefaciens, Serratia rubidaea, S rubidaea, Serratia odorifera, S odorifera, Serratia sepsis, Serratia urinary tract infection, Serratia UTI, Serratia meningitis, Serratia cerebral abscess, Serratia keratitis , Serratia parotitis, Serratia bacteremia

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Contributor Information and Disclosures

Author

Basilio J Anía, MD, Consultant in Internal Medicine, Associate Professor of Infectious Diseases, Department of Internal Medicine, Division of Infectious Diseases, Hospital Negrín & Universidad de Las Palmas de Gran Canaria, Spain
Disclosure: Nothing to disclose.

Medical Editor

Thomas Herchline, MD, Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio
Thomas Herchline, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

John L Brusch, MD, FACP, Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance
John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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