Serratia marcescens: Difference between revisions

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10. http://jb.asm.org/cgi/reprint/114/3/999.pdf
10. http://jb.asm.org/cgi/reprint/114/3/999.pdf
===Antimicrobial regimen===
===Antimicrobial regimen===
:*'''1.Bacteremia,Pneumonia or SeriousInfections'''<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>
:* 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>
::*Preferred regimen : [[Cefepime]] 1-2 g IV q8h {{or}} [[Imipenem]] 0.5-1.0 g IV q6h {{or}} [[Ciprofloxacin]] 400mg IV q8h.
::* 1. '''Bacteremia, pneumonia or serious infections'''
::*Alternative regimen : [[Aztreonam]], [[Gentamicin]] {{or}} [[Amikacin]] {{or}} [[Piperacillin]]/[[tazobactam]] also often effective.
:::* Preferred regimen (1): [[Cefepime]] 1-2 g IV q8h
::*Note : Duration depends on clinical response,usually 7-14days.
:::* Preferred regimen (2): [[Imipenem]] 0.5-1.0 g IV q6h
:*'''2.Endocarditis'''<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>
:::* Preferred regimen (3): [[Ciprofloxacin]] 400 mg IV q8h
::*Preferred regimen : Choice dictated by sensitivities. 4to6 week duration of parenteral therapy.
:::* Alternative regimen (1): [[Aztreonam]]
:*'''3.Osteomyelitis'''<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>
:::* Alternative regimen (2): [[Gentamicin]]  
::*Preferred regimen : Choice dictated by sensitivity profile. Treat for 6-12weeks depending upon response. Use IV treatment until stable/clinically improved(10-14days min)then may convert to PO therapy if appropriate
:::* Alternative regimen (3): [[Amikacin]]  
:*'''4.UTI'''<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>
:::* Alternative regimen (4): [[Piperacillin-tazobactam]] also often effective
::*Preferred regimen : [[Ciprofloxacin]] 250mg PO bid or 400mg IV q12h {{or}} [[Levofloxacin]] 250mg PO everyday or 500mg IV q24h
:::* Note: Duration depends on clinical response, usually 7-14 days
::*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.
::* 2. '''Endocarditis'''
:::* Note: Choice dictated by sensitivities, 4 to 6 week duration of parenteral therapy.
::* 3. '''Osteomyelitis'''
:::* Note (1): Choice dictated by sensitivity profile, treat for 6-12 weeks depending upon response.  
:::* Note (2): Use IV treatment until stable/clinically improved (10-14 days Minimum) then may convert to oral therapy if appropriate.
::* 4. '''UTI'''
:::* Preferred regimen (1): [[Ciprofloxacin]] 250 mg PO bid or 400 mg IV q12h  
:::* Preferred regimen (2): [[Levofloxacin]] 250 mg PO qd or 500mg IV q24h
:::* 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.
 
==Gallery==
==Gallery==


Revision as of 20:44, 28 July 2015

Serratia marcescens
S. marcescens on an XLD agar plate.
S. marcescens on an XLD agar plate.
Scientific classification
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Gamma Proteobacteria
Order: Enterobacteriales
Family: Enterobacteriaceae
Genus: Serratia
Species: S. marcescens
Binomial name
Serratia marcescens
Bizio 1823

Serratia marcescens is a species of Gram-negative bacterium in the family Enterobacteriaceae. A human pathogen, S. marcescens is involved in nosocomial infections, particularly urinary tract infections and wound infections.[1]

S. marcescens (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+.[2]

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.

Pathogenesis

S. marcescens can cause conjunctivitis, keratitis, endophthalmitis, and tear duct infections. It is common in the respiratory and urinary tracts of adults and the gastrointestinal system of children.[3] Most S. marcescens strains are resistant to several antibiotics because of the presence of R-factors, which are a type of plasmid that carry one or more genes that encode resistance.

In coral, S. marcescens is the cause of the disease known as White pox.[citation needed] In silkworms, it sometimes occurs as a secondary pathogen in viral flacherie disease.[citation needed]

Historical

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 United States Military.[4][5] 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.[6],[7]

Since 1950, S. marcescens has steadily increased as a cause of human infection, with many strains resistant to multiple antibiotics.[1] The first indications of problems with the influenza vaccine produced by Chiron Corporation in 2004 involved S. marcescens contamination.

Because of its red pigmentation, caused by expression of the pigment prodigiosin,[8] 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 Bohemian 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.[9]

9. Brown, Alfred E (2007). Benson's Microbiological Applications. 10. http://jb.asm.org/cgi/reprint/114/3/999.pdf

Antimicrobial regimen

  • Serratia marcescens[10]
  • 1. Bacteremia, pneumonia or serious infections
  • 2. Endocarditis
  • Note: Choice dictated by sensitivities, 4 to 6 week duration of parenteral therapy.
  • 3. Osteomyelitis
  • Note (1): Choice dictated by sensitivity profile, treat for 6-12 weeks depending upon response.
  • Note (2): Use IV treatment until stable/clinically improved (10-14 days Minimum) then may convert to oral therapy if appropriate.
  • 4. UTI
  • Preferred regimen (1): Ciprofloxacin 250 mg PO bid or 400 mg IV q12h
  • Preferred regimen (2): Levofloxacin 250 mg PO qd or 500mg IV q24h
  • 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.

Gallery

References

  1. ↑ 1.0 1.1 Hejazi A, Falkiner FR (1997). "Serratia marcescens". J Med Microbiol. 46 (11): 903–12. PMID 9368530.
  2. ↑ [1]
  3. ↑ "Serratia Marcescens seton implant infection & orbital cellulitis". EyeRounds.org. Retrieved 2006-04-06.
  4. ↑ http://www.democracynow.org/article.pl?sid=05/07/13/1357237
  5. ↑ http://archive.webactive.com/pacifica/demnow/dn980220.html
  6. ↑ Cole, Leonard A. (1988). Clouds of Secrecy: The Army's Germ-Warfare Tests Over Populated Areas. (Foreword by Alan Cranston.). Totowa, New Jersey: Rowman & Littlefield. ISBN 0-8476-7579-3.
  7. ↑ Regis, Ed. The Biology of Doom : America's Secret Germ Warfare Project. Diane Publishing Company. ISBN 0-7567-5686-3.
  8. ↑ Bennett JW, Bentley R (2000). "Seeing red: The story of prodigiosin". Adv Appl Microbiol. 47: 1–32. PMID 12876793.
  9. ↑ "The Mass at Bolsena by Raphael". Vatican Museums. Retrieved 2006-05-03.
  10. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  11. ↑ "Public Health Image Library (PHIL)".

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