- Author: Basilio J Anía, MD; Chief Editor: Michael Stuart Bronze, MD more...
Serratia species are opportunistic gram-negative bacteria classified in the tribe Klebsielleae and the large family Enterobacteriaceae. Serratia are widespread in the environment, but are not a common component of the human fecal flora.
Serratia marcescens is the primary pathogenic species of Serratia. Rare reports have described disease resulting from infection with Serratia plymuthica, Serratia liquefaciens, Serratia rubidaea, Serratia odorifera, and Serratia fonticola.
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. The chemical structure of prodigiosin has been unveiled. Serratia are capable of thriving in diverse environments, including water, soil, and the digestive tracts of various animals. 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.
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.
Derivatives of prodigiosin have recently been found to have immunosuppressive properties and antitumor activity in vivo[11, 12] and are also currently being considered as a candidate treatment for Chagas disease.
It appears that at least some Serratia isolates interfere with macrophage function or viability. 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. An outbreak of S marcescens bloodstream infections was identified in patients receiving contaminated bags of parenteral nutrition. Outbreaks of S marcescensmeningitis, wound infections, and arthritis have occurred in pediatric wards.
Cases of Serratia septic arthritis have been reported in outpatients receiving intra-articular injections.
An outbreak of meningitis caused by S marcescens in patients who had undergone spinal anaesthesia for caesarean section has been ascribed to contaminated medications used for this purpose.
Serratia species are responsible for 1.4% of nosocomial bloodstream infections.
The yearly incidence of Serratia bacteremia is 1.03 per 100,000 population, with 47% of episodes having their onset in the community.
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.
In the University Hospital of Heraklion, Crete, S marcescens was isolated in 65 (84.4%) of 77 patients with Serratia infection; the remaining 12 patients had infection with a nonmarcescens Serratia species. The most frequently observed infections were respiratory tract infection (32.5%) and keratitis/endophthalmitis (20.8%).
In a population-based study of Serratia bacteremia, the 7-day and 6-month mortality rates were 5% and 37%, respectively.
Serratia meningitis and Serratia endocarditis carry a high mortality rate.
Serratia species cause less than 6% of cases of hospital-acquired bacterial pneumonia.
S marcescens causes 11% of burn-related surgical wound infections.
Most (68%) episodes of Serratia bacteremia occur in males.
Outbreaks of Serratia infection occur in neonates and infants. In adults, most Serratia infections are isolated, but occasional nosocomial outbreaks occur.
Donnenberg MS. Enterobacteriaceae. Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th. Philadelphia, Pa: Churchill Livingstone - Elsevier; 2010. Vol 2: 2815-2833.
Carrero P, Garrote JA, Pacheco S, et al. Report of six cases of human infection by Serratia plymuthica. J Clin Microbiol. 1995 Feb. 33(2):275-6. [Medline].
Grohskopf LA, Roth VR, Feikin DR, et al. Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center. N Engl J Med. 2001 May 17. 344(20):1491-7. [Medline].
Ursua PR, Unzaga MJ, Melero P, et al. Serratia rubidaea as an invasive pathogen. J Clin Microbiol. 1996 Jan. 34(1):216-7. [Medline].
Julie G, Julie C, Anne G, Bernard F, Philippe V, Madeleine C, et al. Childhood delayed septic arthritis of the knee caused by Serratia fonticola. Knee. 2009 Dec. 16(6):512-4. [Medline].
Elahian F, Moghimi B, Dinmohammadi F, Ghamghami M, Hamidi M, Mirzaei SA. The anticancer agent prodigiosin is not a multidrug resistance protein substrate. DNA Cell Biol. 2013 Mar. 32(3):90-7. [Medline]. [Full Text].
Petersen LM, Tisa LS. Friend or foe? A review of the mechanisms that drive Serratia towards diverse lifestyles. Can J Microbiol. 2013 Sep. 59(9):627-40. [Medline].
Anonymous. The miracle microbe: Serratia marcescens. [Full Text].
Yu VL. Serratia marcescens: historical perspective and clinical review. N Engl J Med. 1979 Apr 19. 300(16):887-93. [Medline].
Pérez-Tomás R, Viñas M. New insights on the antitumoral properties of prodiginines. Curr Med Chem. 2010. 17(21):2222-31. [Medline].
Chang CC, Chen WC, Ho TF, Wu HS, Wei YH. Development of natural anti-tumor drugs by microorganisms. J Biosci Bioeng. 2011 May. 111(5):501-11. [Medline].
Genes C, Baquero E, Echeverri F, Maya JD, Triana O. Mitochondrial dysfunction in Trypanosoma cruzi: the role of Serratia marcescens prodigiosin in the alternative treatment of Chagas disease. Parasit Vectors. 2011 May 6. 4:66. [Medline]. [Full Text].
Remuzgo-Martínez S, Aranzamendi-Zaldunbide M, Pilares-Ortega L, Icardo JM, Acosta F, Martínez-Martínez L, et al. Interaction of macrophages with a cytotoxic Serratia liquefaciens human isolate. Microbes Infect. 2013 Jun. 15(6-7):480-90. [Medline].
Gupta N, Hocevar SN, Moulton-Meissner HA, Stevens KM, McIntyre MG, Jensen B, et al. Outbreak of Serratia marcescens Bloodstream Infections in Patients Receiving Parenteral Nutrition Prepared by a Compounding Pharmacy. Clin Infect Dis. 2014 Apr 11. [Medline].
Ersoz G, Uguz M, Aslan G, Horasan ES, Kaya A. Outbreak of meningitis due to Serratia marcescens after spinal anaesthesia. J Hosp Infect. 2014 Jun. 87(2):122-5. [Medline].
Engel HJ, Collignon PJ, Whiting PT, Kennedy KJ. Serratia sp. bacteremia in Canberra, Australia: a population-based study over 10 years. Eur J Clin Microbiol Infect Dis. 2009 Jul. 28(7):821-4. [Medline].
Samonis G, Vouloumanou EK, Christofaki M, Dimopoulou D, Maraki S, Triantafyllou E, et al. Serratia infections in a general hospital: characteristics and outcomes. Eur J Clin Microbiol Infect Dis. 2011 May. 30(5):653-60. [Medline].
Jones RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis. 2010 Aug 1. 51 Suppl 1:S81-7. [Medline].
Rastogi V, Purohit P, Peters BP, et al. Pulmonary infection with serratia marcescens. Indian J Med Microbiol. 2002 Jul-Sep. 20(3):167-8. [Medline].
Zarogoulidis P, Porpodis K, Konoglou M, Saroglou M, Mitrakas A, Matthaios D, et al. Serratia pneumonia presenting as hemoptysis in a patient with sarcoidosis: a case report. Int J Gen Med. 2011. 4:661-4. [Medline]. [Full Text].
Wu YM, Hsu PC, Yang CC, Chang HJ, Ye JJ, Huang CT, et al. Serratia marcescens meningitis: Epidemiology, prognostic factors and treatment outcomes. J Microbiol Immunol Infect. 2012 Aug 24. [Medline].
Hiremath S, Biyani M. Technique survival with Serratia peritonitis. Adv Perit Dial. 2006. 22:73-6. [Medline].
Friend JC, Hilligoss DM, Marquesen M, Ulrick J, Estwick T, Turner ML, et al. Skin ulcers and disseminated abscesses are characteristic of Serratia marcescens infection in older patients with chronic granulomatous disease. J Allergy Clin Immunol. 2009 Jul. 124(1):164-6. [Medline]. [Full Text].
al Hazzaa SA, Tabbara KF, Gammon JA. Pink hypopyon: a sign of Serratia marcescens endophthalmitis. Br J Ophthalmol. 1992 Dec. 76(12):764-5. [Medline].
Faro J, Katz A, Berens P, Ross PJ. Premature termination of nursing secondary to Serratia marcescens breast pump contamination. Obstet Gynecol. 2011 Feb. 117(2 Pt 2):485-6. [Medline].
Jones J, Crete J, Neumeier R. A case report of pink breast milk. J Obstet Gynecol Neonatal Nurs. 2014 Sep. 43(5):625-30. [Medline].
Ostrowsky BE, Whitener C, Bredenberg HK, et al. Serratia marcescens bacteremia traced to an infused narcotic. N Engl J Med. 2002 May 16. 346(20):1529-37. [Medline].
Sunenshine RH, Tan ET, Terashita DM, et al. A multistate outbreak of Serratia marcescens bloodstream infection associated with contaminated intravenous magnesium sulfate from a compounding pharmacy. Clin Infect Dis. 2007 Sep 1. 45(5):527-33. [Medline].
Horcajada JP, Martinez JA, Alcon A, et al. Acquisition of multidrug-resistant Serratia marcescens by critically ill patients who consumed tap water during receipt of oral medication. Infect Control Hosp Epidemiol. 2006 Jul. 27(7):774-7. [Medline].
Mills J, Drew D. Serratia marcescens endocarditis: a regional illness associated with intravenous drug abuse. Ann Intern Med. 1976 Jan. 84(1):29-35. [Medline].
Pinna A, Usai D, Sechi LA, Carta A, Zanetti S. Detection of virulence factors in Serratia strains isolated from contact lens-associated corneal ulcers. Acta Ophthalmol. 2011 Jun. 89(4):382-7. [Medline].
Friedman ND, Peterson NB, Sumner WT, et al. Spontaneous dermal abscesses and ulcers as a result of Serratia marcescens. J Am Acad Dermatol. 2003 Aug. 49(2 Suppl Case Reports):S193-4. [Medline].
Mlynarczyk A, Mlynarczyk G, Pupek J, et al. Serratia marcescens isolated in 2005 from clinical specimens from patients with diminished immunity. Transplant Proc. 2007 Nov. 39(9):2879-82. [Medline].
Bertrand X, Dowzicky MJ. Antimicrobial susceptibility among gram-negative isolates collected from intensive care units in North America, Europe, the Asia-Pacific Rim, Latin America, the Middle East, and Africa between 2004 and 2009 as part of the Tigecycline Evaluation and Surveillance Trial. Clin Ther. 2012 Jan. 34(1):124-37. [Medline].
Sader HS, Farrell DJ, Flamm RK, Jones RN. Antimicrobial susceptibility of Gram-negative organisms isolated from patients hospitalized in intensive care units in United States and European hospitals (2009-2011). Diagn Microbiol Infect Dis. 2014 Apr. 78(4):443-8. [Medline].
Tamma PD, Girdwood SC, Gopaul R, Tekle T, Roberts AA, Harris AD, et al. The use of cefepime for treating AmpC ß-lactamase-producing Enterobacteriaceae. Clin Infect Dis. 2013 Sep. 57(6):781-8. [Medline].
Curtis L. Handwashing and other environmental controls needed to prevent hospital-acquired serratia infections. J Chemother. 2009 Aug. 21(4):470. [Medline].
de Vries JJ, Baas WH, van der Ploeg K, et al. Outbreak of Serratia marcescens colonization and infection traced to a healthcare worker with long-term carriage on the hands. Infect Control Hosp Epidemiol. 2006 Nov. 27(11):1153-8. [Medline].
Alonso Fernandez R, Baquero Mochales F. [The genus Serratia: its biology, clinical effects and epidemiology]. Rev Clin Esp. 1994 Apr. 194(4):294-9. [Medline].
Aron M, Goel R, Gupta NP, et al. Incidental detection of purulent fluid in kidney at percutaneous nephrolithotomy for branched renal calculi. J Endourol. 2005 Mar. 19(2):136-9. [Medline].
Bosi C, Davin-Regli A, Charrel R, et al. Serratia marcescens nosocomial outbreak due to contamination of hexetidine solution. J Hosp Infect. 1996 Jul. 33(3):217-24. [Medline].
Bruckner DA, Colonna P, Bearson BL. Nomenclature for aerobic and facultative bacteria. Clin Infect Dis. 1999 Oct. 29(4):713-23. [Medline].
Buffet-Bataillon S, Rabier V, Bétrémieux P, Beuchée A, Bauer M, Pladys P, et al. Outbreak of Serratia marcescens in a neonatal intensive care unit: contaminated unmedicated liquid soap and risk factors. J Hosp Infect. 2009 May. 72(1):17-22. [Medline].
Capitano B, Nicolau DP, Potoski BA, et al. Meropenem administered as a prolonged infusion to treat serious gram-negative central nervous system infections. Pharmacotherapy. 2004 Jun. 24(6):803-7. [Medline].
Civen R, Vugia DJ, Alexander R, et al. Outbreak of Serratia marcescens infections following injection of betamethasone compounded at a community pharmacy. Clin Infect Dis. 2006 Oct 1. 43(7):831-7. [Medline].
Cohen SM, Flynn HW Jr, Miller D. Endophthalmitis caused by Serratia marcescens. Ophthalmic Surg Lasers. 1997 Mar. 28(3):195-200. [Medline].
Cunha G, Leão L, Pimenta F. Bacterial contamination of random-donor platelets in a university hospital in the midwestern region of Brazil. Transfusion. 2008 Feb. 48(2):282-5. [Medline].
de Boer MG, Brunsveld-Reinders AH, Salomons EM, Dijkshoorn L, Bernards AT, van den Berg PC, et al. Multifactorial origin of high incidence of Serratia marcescens in a cardio-thoracic ICU: analysis of risk factors and epidemiological characteristics. J Infect. 2008 Jun. 56(6):446-53. [Medline].
Demetriou CA, Cunha BA. Serratia marcescens bacteremia after carotid endarterectomy and coronary artery bypass grafting. Heart Lung. 1999 Jul-Aug. 28(4):293-4. [Medline].
Dominguez Herrera JM, Jimenez Mejias ME, et al. [Acute bacterial parotitis caused by Serratia marcescens]. Rev Clin Esp. 1996 Apr. 196(4):271-2. [Medline].
Edmond MB, Wallace SE, McClish DK, et al. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis. 1999 Aug. 29(2):239-44. [Medline].
Edson RS, Terrell CL. The aminoglycosides. Mayo Clin Proc. 1999 May. 74(5):519-28. [Medline].
Gurevich I, Tafuro PA, Cunha BA. Serratia peritonitis in hemodialysis patients. Clinical Microbiology Newsletter. 1987. 9:55-56.
Haddy RI, Mann BL, Nadkarni DD, et al. Nosocomial infection in the community hospital: severe infection due to Serratia species. J Fam Pract. 1996 Mar. 42(3):273-7. [Medline].
Hejazi A, Falkiner FR. Serratia marcescens. J Med Microbiol. 1997 Nov. 46(11):903-12. [Medline].
Hellinger WC, Brewer NS. Carbapenems and monobactams: imipenem, meropenem, and aztreonam. Mayo Clin Proc. 1999 Apr. 74(4):420-34. [Medline].
Heltberg O, Skov F, Gerner-Smidt P, et al. Nosocomial epidemic of Serratia marcescens septicemia ascribed to contaminated blood transfusion bags. Transfusion. 1993 Mar. 33(3):221-7. [Medline].
Hertle R, Schwarz H. Serratia marcescens internalization and replication in human bladder epithelial cells. BMC Infect Dis. 2004 Jun 9. 4:16. [Medline].
Hsieh S, Babl FE. Serratia marcescens cellulitis following an iguana bite. Clin Infect Dis. 1999 May. 28(5):1181-2. [Medline].
Jean SS, Hsueh PR, Lee WS, Chang HT, Chou MY, Chen IS, et al. Nationwide surveillance of antimicrobial resistance among Enterobacteriaceae in intensive care units in Taiwan. Eur J Clin Microbiol Infect Dis. 2009 Feb. 28(2):215-20. [Medline].
Johnson DH, Cunha BA, Klein NC. Serratia. Infect Dis Pract. 1993. 17:6-8.
Johnson JS, Croall J, Power JS, et al. Fatal Serratia marcescens meningitis and myocarditis in a patient with an indwelling urinary catheter. J Clin Pathol. 1998 Oct. 51(10):789-90. [Medline].
Kirschke DL, Jones TF, Craig AS, et al. Pseudomonas aeruginosa and Serratia marcescens contamination associated with a manufacturing defect in bronchoscopes. N Engl J Med. 2003 Jan 16. 348(3):214-20. [Medline].
Manfredi R, Nanetti A, Ferri M, et al. Clinical and microbiological survey of Serratia marcescens infection during HIV disease. Eur J Clin Microbiol Infect Dis. 2000 Apr. 19(4):248-53. [Medline].
McLeod SD, Goei SL, Taglia DP, et al. Nonulcerating bacterial keratitis associated with soft and rigid contact lens wear. Ophthalmology. 1998 Mar. 105(3):517-21. [Medline].
Munoz G, Alio JL, Perez-Santonja JJ, et al. Ulcerative keratitis caused by Serratia marcescens after laser in situ keratomileusis. J Cataract Refract Surg. 2004 Feb. 30(2):507-12. [Medline].
Pai HH, Chen WC, Peng CF. Cockroaches as potential vectors of nosocomial infections. Infect Control Hosp Epidemiol. 2004 Nov. 25(11):979-84. [Medline].
Royo P, del Valle O, Boquete T. [Epidemiology of Serratia marcescens between 1987 and 1995 at Vall d'Hebron Hospital]. Enferm Infecc Microbiol Clin. 1997 Dec. 15(10):519-27. [Medline].
Sehdev PS, Donnenberg MS. Arcanum: The 19th-century Italian pharmacist pictured here was the first to characterize what are now known to be bacteria of the genus Serratia. Clin Infect Dis. 1999 Oct. 29(4):770, 925. [Medline].
Shigemura K, Arakawa S, Tanaka K, Fujisawa M. Clinical investigation of isolated bacteria from urinary tracts of hospitalized patients and their susceptibilities to antibiotics. J Infect Chemother. 2009 Feb. 15(1):18-22. [Medline].
Shih HI, Lee HC, Lee NY, et al. Serratia marcescens bacteremia at a medical center in southern Taiwan: high prevalence of cefotaxime resistance. J Microbiol Immunol Infect. 2005 Oct. 38(5):350-7. [Medline].
Sickbert-Bennett EE, Weber DJ, Gergen-Teague MF, et al. Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses. Am J Infect Control. 2005 Mar. 33(2):67-77. [Medline].
Sokalski SJ, Jewell MA, Asmus-Shillington AC, et al. An outbreak of Serratia marcescens in 14 adult cardiac surgical patients associated with 12-lead electrocardiogram bulbs. Arch Intern Med. 1992 Apr. 152(4):841-4. [Medline].
Su JR, Blossom DB, Chung W, Gullion JS, Pascoe N, Heseltine G, et al. Epidemiologic investigation of a 2007 outbreak of Serratia marcescens bloodstream infection in Texas caused by contamination of syringes prefilled with heparin and saline. Infect Control Hosp Epidemiol. 2009 Jun. 30(6):593-5. [Medline].
Tanaka T, Takahashi H, Kobayashi JM, et al. A nosocomial outbreak of febrile bloodstream infection caused by heparinized-saline contaminated with Serratia marcescens, Tokyo, 2002. Jpn J Infect Dis. 2004 Oct. 57(5):189-92. [Medline].
van der Vorm ER, Woldring-Zwaan C. Source, carriers, and management of a Serratia marcescens outbreak on a pulmonary unit. J Hosp Infect. 2002 Dec. 52(4):263-7. [Medline].
Weinstein RA. Lessons from an epidemic, again. N Engl J Med. 2001 May 17. 344(20):1544-5. [Medline].
Yannelli B, Schoch PA, Cunha BA. Serratia infections in the hospital. Clinical Microbiology Newsletter. 1987. 9:157-160.