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| Year : 1984 | Volume
: 30
| Issue : 2 | Page : 89-90 |
Nosocomial infections due to Serratia marcescens.
Deodhar LP, Tendolkar UM
How to cite this article:
Deodhar L P, Tendolkar U M. Nosocomial infections due to Serratia marcescens. J Postgrad Med 1984;30:89-90 |
Serratia marcescens, a member of the family Enterobacteriaceae, Tribe Klebsiellae, has been reported with increasing frequency as a cause of nosocomial infections. Its association with infections such as septicaemia, meningitis, empyema, osteomyelitis etc., is alarming.[4] Once considered a normal commensal of the intestine and a saprophyte, it has now been regarded as an opportunistic pathogen, developing resistance to a large number of antimicrobial agents and antiseptics. Very few reports are available in the Indian literature.
Samples like ear swabs, sputum, blood, bronchoscopic aspirates, nasal and pharyngeal swabs etc. were processed in the laboratory. Standard procedures as recommended by Gradwohl[6] were used for identification of Serratia marcescens. The antibiotic susceptibility tests were done by the disc diffusion technique and concentration of the various drugs used was as given by Cruickshank.[3] Environmental studies were carried out whenever required. These included bacteriological studies of tables and trays used for keeping equipments, water and glutaraldehyde solutions used to irrigate the bronchoscope, saline and the bronchoscope itself. Typing of the strains or serogrouping was not done.
In a period of one year, 16 strains of Serratia marcescens were isolated from patients' clinical samples with the diagnosis of pneumonitis, otitis media, empyema, blood transfusion reaction, peritonitis, pneumonia etc. Their identification was based on following important features:
(1) Motile Gram negative bacilli.
(2) Red pigment producing colonies on culture plates and
(3) Biochemical reactions like fermentation of sorbitol with acid production; no fermentation of arabinose and gelatin liquifaction within 24 hours at room temperature. These reactions were useful to differentiate S. marcescens from other species. All the strains were sensitive to gentamicin, kanamycin and chloramphenicol. Six strains (37.5%) were sensitive to ampicillin.
Results of environmental studies
In a short period of two weeks, we had 7 bronchoscopic aspirates where Serratia marcescens were isolated in pure culture, This led us to investigate and find out the source of contamination. Serratia marcescens was isolated even from saline, which was used to aspirate viscid bronchia1 secretions.
In another case, a patient operated for subclavian artery aneurysm was given Mood transfusion post-operatively. As the patient developed rigors, transfusion was stopped. Serratia marcescens was isolated from this patient's blood and blood transfusion bottle.
Remaining cases were sporadic and the isolation of Serratia was spread out over a period of 6 months.
Isolation of 16 strains of Serratia marcescens in a period of one year is significant. Their isolation in seven consecutive bronchoscopic aspirates led us to investigate other various samples and it was possible to find out the source of contamination. Reports by various workers[1],[5] indicate that in wards where Serratia infections occur, the bacterium has been recovered from the patient, inanimate environment. In an outbreak due to multiple drug resistant Serratia marcescens in a children's hospital in Delhi,[2] extensive environmental studies were carried out but the source of epidemic strain could not be located in the environment.
Simultaneous culturing of patient's blood and blood bottle sample helped us to find out the source of infection.
In the remaining it was possible to pinpoint the source of infection.
Many hospitals have reported that most of their Serratia strains were antibiotic resistant. In the present study, the strains were found sensitive to gentamicin, kanamycin and chloramphenicol though the sensitivity results for other drugs were variable.
We are thankful to the Dean, L.T.M. Medical College, Sion, for allowing us to publish this paper.
| 1. | Cabrera. H. A.: An outbreak of Serratia marcescens and ills control. Arch.. Intern. Med., 123: 650-655, 1989.  |
| 2. | Chakravarti, A., Mandal, A. and Sharma, K. B.: An outbreak die to multiple drug resistant Serratia marcescens in children's hospital. Ind. J. Med. Res., 74: 196-201, 1981. |
| 3. | Cruickshank, R., Duguid, J. P., Marmion, B. P. and Swain, R. H. A.: Disc diffusion tests of sensitivity to antibiotics. In, "Medical Microbiology", Vol. 2. 121h edition. Churchill Livingstone, Edinburgh. London and New York, 1975, pp. 19"0-200. |
| 4. | Lai, P. S.. Ngeow, Y. F.. Puthucheary, S. D. and Wang, Chee, W.: Comparison of two methods for bacteriocin typing of Serratia marcescens. J. Clin. Microbiol., 17: 1-6, 1983. |
| 5. | Rigrose, R. E.. McKeown, B., Felton, F. G., Barclay. B. 7., Muchmore, H. G., and Rhoades, E. R.: A hospital outbreak of Serratia marcescens associated with ultrasonic nebulizers. Ann. Int. Med., 62: 719-729. 1988. |
| 6. | Sonnenwirth, A. C.: Gram negative bacilli, vibrios and spirilla. In, "Gradwohl's Clinical Laboratory Methods and Diagnosis". Editors: A. D. Sonnerwirth and L. Jarrett, 8th Edition, C. V. Mosby and Company. Saint Louis, Toronto and London, 1980. pp. 1784-1785. |
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