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| {{Taxobox
| | #Redirect [[Serratia]] |
| | color = lightgrey
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| | name = ''Serratia marcescens''
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| | image = Serratia marcescens 01.jpg
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| | image_width = 240px
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| | image_caption = ''S. marcescens'' on an XLD agar plate.
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| | regnum = [[Bacterium|Bacteria]]
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| | phylum = [[Proteobacteria]]
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| | classis = [[Gamma Proteobacteria]]
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| | ordo = [[Enterobacteriaceae|Enterobacteriales]]
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| | familia = [[Enterobacteriaceae]]
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| | genus = ''[[Serratia]]''
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| | species = '''''S. marcescens'''''
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| | binomial = ''Serratia marcescens''
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| | binomial_authority = Bizio 1823
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| }}
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| '''''Serratia marcescens''''' is a species of [[Gram-negative]] [[bacterium]] in the family [[Enterobacteriaceae]]. A human [[pathogen]], ''S. marcescens'' is involved in [[nosocomial infection]]s, particularly [[urinary tract infection]]s and wound infections.<ref name=Hejazi_1997>{{cite journal | author=Hejazi A, Falkiner FR | title=Serratia marcescens | journal=J Med Microbiol | year=1997 | pages=903-12 | volume=46 | issue=11 | id= PMID 9368530 }}</ref>
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| ''S. marcescens'' ([[bacilli|bacillus]]), [[motile]] organism and can grow in temperatures ranging from 5–40°C and in [[pH]] levels ranging from 5 to 9. ''S. marcescens'' is differentiated from other Gram-negative bacteria, as it is able to perform [[casein]] [[hydrolysis]]. Performing casein hydrolysis allows for ''S. marcescens'' to produce extracellular metalloproteases which are believed to function in cell-to-extracellular matrix interactions. ''S. marcescens'' also exhibits [[tryptophan]]- and [[citrate]]-degradation. One of the end products of tryptophan degradation is [[pyruvic acid]], which is then incorporated into different metabolic processes of ''S. marcescens''. A final product of citrate degradation is carbon. Thus, ''S. marcescens'' can rely on citrate as a carbon source. In identifying the organism one may also perform a ''[[methyl red]] test'', which determines if a microorganism performs mixed-acid fermentation. ''S. marcescens'' results in a negative test. Another determination of ''S. marcescens'' is its capability to produce [[lactic acid]] via oxidative and fermentative metabolism. Therefore, it is said that ''S. marcescens'' is lactose O/F+.<ref>[http://soils1.cses.vt.edu/ch/biol_4684/Microbes/Serratia.html]</ref>
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| Due to its ubiquitous presence in the environment, and its preference for damp conditions, ''S. marcescens'' is commonly found growing in bathrooms (especially on tile grout), where it manifests as a pink discoloration. Once established, complete eradication of the organism is often difficult, but can be accomplished by application of a [[bleach]]-based disinfectant.''S. marcescens'' may also be found in environments such as dirt, supposedly "sterile" places, and the subgingival biofilm of teeth. Due to this, and the fact that S. marcescens produces a reddish-orange pigment called [[prodigiosin]], S. marcescens may cause extrinsic staining of the teeth. The biochemical pathway illustrating the production of prodigiosin by S. marcescens is unknown except for the final two steps. In these steps, a monopyrrole (MAD) and a bipyrrole (MBC) undergo a condensation reaction by way of a condensing enzyme to ultimately form the tripyrrole pigment, prodigiosin.
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| ==Pathogenesis==
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| ''S. marcescens'' can cause [[conjunctivitis]], [[keratitis]], [[endophthalmitis]], and [[tear duct]] [[infections]]. It is common in the respiratory and [[urinary tract]]s of adults and the [[gastrointestinal system]] of children.<ref>{{cite web | title=''Serratia Marcescens'' seton implant infection & orbital cellulitis | work=EyeRounds.org | url=http://webeye.ophth.uiowa.edu/eyeforum/cases/case34-setoninfection.htm| accessdate=2006-04-06}}</ref> Most ''S. marcescens'' strains are resistant to several [[antibiotic]]s because of the presence of [[R-factor]]s, which are a type of [[plasmid]] that carry one or more genes that encode [[Antibiotic resistance|resistance]].
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| In [[coral]], ''S. marcescens'' is the cause of the disease known as ''[[White pox]]''.{{Fact|date=August 2007}} In [[silkworm]]s, it sometimes occurs as a secondary pathogen in viral [[flacherie]] disease.{{Fact|date=August 2007}}
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| ==Historical==
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| In the [[1950s]] ''S. marcescens'' was erroneously believed to be non-pathogenic and its reddish coloration was used in school experiments to track infections. It has also been used as a simulant in [[biological warfare]] tests by the [[Military of the United States|United States Military]].<ref>http://www.democracynow.org/article.pl?sid=05/07/13/1357237</ref><ref>http://archive.webactive.com/pacifica/demnow/dn980220.html</ref> On September 26 and 27, 1950, the [[United States Navy]] conducted a secret experiment named "[[Operation Sea-Spray]]" in which some ''S. marcescens'' was released by bursting balloons of it over urban areas of the [[San Francisco Bay Area]] in [[California]]. Although the Navy later claimed the bacteria were harmless, beginning on September 29 eleven patients at a local hospital developed very rare, serious urinary tract infections and one of these individuals, [[Edward J. Nevin]], died. Cases of pneumonia in San Francisco also increased after ''S. marcescens'' was released.<ref>{{cite book | author = Cole, Leonard A. | title = Clouds of Secrecy: The Army's Germ-Warfare Tests Over Populated Areas. (Foreword by Alan Cranston.) | edition = | location= Totowa, New Jersey | publisher=Rowman & Littlefield. | year = 1988 | id = ISBN 0-8476-7579-3}}</ref><sup>,</sup><ref>{{cite book | author = Regis, Ed | title = The Biology of Doom : America's Secret Germ Warfare Project. | edition = | publisher = Diane Publishing Company. | year = | id = ISBN 0-7567-5686-3 }}</ref>
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| Since 1950, ''S. marcescens'' has steadily increased as a cause of human infection, with many strains resistant to multiple antibiotics.<ref name=Hejazi_1997 /> The first indications of problems with the [[flu vaccine|influenza vaccine]] produced by [[Chiron Corporation]] in [[2004]] involved ''S. marcescens'' contamination.
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| Because of its red pigmentation, caused by expression of the [[pigment]] prodigiosin,<ref>{{cite journal | author=Bennett JW, Bentley R | title= Seeing red: The story of prodigiosin | journal=Adv Appl Microbiol | year=2000 | pages=1-32 | volume=47 | id={{PMID|12876793}} }}</ref> and its ability to grow on bread, ''S. marcescens'' has been evoked as a naturalistic explanation of [[Medieval]] accounts of the "miraculous" appearance of blood on the [[Eucharist]] that led to [[Pope Urban IV]] instituting the [[Feast of Corpus Christi]] in [[1264]]. This followed celebration of a [[Mass]] at [[Bolsena]] in 1263, led by a [[Bohemia]]n priest who had doubts concerning [[transubstantiation]], or the turning of bread and wine into the body and blood of [[Christ]] during the Mass. During the Mass, the eucharist appeared to bleed and each time the priest wiped away the blood, more would appear. This event is celebrated in a [[fresco]] in the [[Apostolic Palace]] in the [[Vatican City]], painted by [[Raphael]].<ref name=Vatican_Raphael>{{cite web | title=The Mass at Bolsena by Raphael | work=Vatican Museums | url=http://mv.vatican.va/3_EN/pages/x-Schede/SDRs/SDRs_02_01_012.html | accessdate=2006-05-03}}</ref>
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| 9. Brown, Alfred E (2007). Benson's Microbiological Applications.
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| 10. http://jb.asm.org/cgi/reprint/114/3/999.pdf
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| ===Antimicrobial regimen===
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| :* Serratia marcescens<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
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| ::* 1. '''Bacteremia, pneumonia or serious infections'''
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| :::* Preferred regimen (1): [[Cefepime]] 1-2 g IV q8h
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| :::* Preferred regimen (2): [[Imipenem]] 0.5-1.0 g IV q6h
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| :::* Preferred regimen (3): [[Ciprofloxacin]] 400 mg IV q8h
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| :::* Alternative regimen (1): [[Aztreonam]]
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| :::* Alternative regimen (2): [[Gentamicin]]
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| :::* Alternative regimen (3): [[Amikacin]]
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| :::* Alternative regimen (4): [[Piperacillin-tazobactam]] also often effective
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| :::* Note: Duration depends on clinical response, usually 7-14 days
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| ::* 2. '''Endocarditis'''
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| :::* Note: Choice dictated by sensitivities, 4 to 6 week duration of parenteral therapy.
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| ::* 3. '''Osteomyelitis'''
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| :::* Note (1): Choice dictated by sensitivity profile, treat for 6-12 weeks depending upon response.
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| :::* Note (2): Use IV treatment until stable/clinically improved (10-14 days Minimum) then may convert to oral therapy if appropriate.
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| ::* 4. '''UTI'''
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| :::* Preferred regimen (1): [[Ciprofloxacin]] 250 mg PO bid or 400 mg IV q12h
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| :::* Preferred regimen (2): [[Levofloxacin]] 250 mg PO qd or 500mg IV q24h
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| :::* Note: Fluoroquinolones often sensitive but in seriously ill patient consider empiric coverage with two drugs (e.g.,beta-lactam and aminoglycoside or fluoroquinolones and carbapenem) until susceptibilities known.
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| ==Gallery==
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| <gallery>
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| Image: Enterobacteria40.jpeg| Blood agar base plate cultivated colonial growth of Gram-negative, rod-shaped and facultatively anaerobic Serratia marcescens bacteria. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
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| </gallery>
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| ==References==
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| {{Reflist|2}}
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| ==External links==
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| * {{eMedicine|med|2103}}
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| [[Category:Enterobacteria]]
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| [[Category:Gram negative bacteria]]
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