Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients

Objective: In this study, it was aimed to present a cohort study conduct-ed retrospectively in order to examine the unexpected Serratia marc-escens bacteremia prevalence in a children's hospital in Turkiye.Material and Methods: S. marcescens was isolated in the blood cultures of 45 patients at a 20-month period. Demographic features and clini-cal findings of the 45 patients including age, sex, underlying diseases, white blood cell (WBC), C-reactive protein (CRP), serum albumin level, length of hospital stay and length of pediatric intensive care unit stay, portal of entry, duration of central venous catheter, results of antimicro-bial susceptibility testing and 28-day all-cause mortality were examined. Bloodstream infections (BSI) were classified as BSI or catheter-related BSI. Definitions used to characterize antimicrobial resistant bacteria were classified as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR).Results:Twelve patients (26.9%) had a malignancy. Mean hospitalization duration was 42.7 +/- 41.4 (3-171) days. Central venous catheters (CVCs), including chemo-ports and Hickman catheters, were present in 43 pa-tients during episodes of BSI. Twenty-four patients had primary BSI while 21 patients had catheter-related BSI. Mean length of CVC presence be fore catheter-related BSI was 46.02 +/- 50.96 (1-200) days. During bactere-mia episodes, 24 catheters (55.8%) were removed. Four patients (8.9%) died during the bacteremia episode. Laboratory findings of the deceased patients were as follows: mean WBC was 17.200/mm3; mean serum CRP level was 147.2 mg/L; and mean serum albumin level was 2.43 g/dL. Among all cases, 57.8% of the S. marcescens isolates produced ESBL and 40% produced carbapenemase. We classified these isolates as non-MDR (42.2%), MDR (31.1%), XDR (24.4%) and PDR (2.2%). The most common regimes received for XDR isolates were high-dose prolonged meropen-em, amikacin, levofloxacin, and tigecycline.Conclusion: It is a great concern that S. marcescens isolates are intrinsi-cally resistant to polymyxins and produce ESBL and carbapenemase. Our mortality rate was reduced by high-dose prolonged-infusion of mero-penem and early catheter removal.

Automated summary

This study retrospectively examined the epidemiological characteristics of Serratia marcescens in a children's hospital in Turkey. The results showed that S. marcescens isolates exhibited resistance to polymyxins and produced ESBL and carbapenemase. High-dose prolonged-infusion of meropenem and early catheter removal were found to reduce the mortality rate of S. marcescens infection.