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Volume 38, Number 5, October 2005

Serratia marcescens bacteremia at a medical center in southern Taiwan: high prevalence of cefotaxime resistance


Hsin-I Shih, Hsin-Chun Lee, Nan-Yao Lee, Chia-Ming Chang, Chi-Jung Wu, Li-Rong Wang, Nai-Ying Ko, Wen-Chien Ko
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan; Department of Medicine, National Cheng Kung University, Medical College, Tainan; Department of Pathology, National Cheng Kung University Hospital, Tainan; and Department of Nursing, National Cheng Kung University, Medical College, Tainan, Taiwan

Received: March 17, 2005    Revised: May 9, 2005    Accepted: July 19, 2005   

 

Corresponding author:

Wen-Chien Ko, Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, 704, Tainan, Taiwan. E-mail: winston@mail.ncku.edu.tw This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Methods:

Antimicrobial resistance of isolates and risk factors for mortality were retrospectively investigated in 71 adult patients with Serratia marcescens bacteremia. During the 4-year study period, 78 clinically significant episodes of S. marcescens bacteremia occurred in 71 patients. The mean age of the patients was 65 years (range, 25-86 years) with a male predominance (45 patients, 63%). Most of the bacteremic episodes were nosocomial (78%), and 34% were polymicrobial. The overall mortality rate within 2 weeks after the onset of bacteremia was 41%. The presence of malignancy and critical illness at initial presentation were independent risk factors for mortality. By disk susceptibility test, 72 isolates were resistant to cefotaxime (92%) but susceptible to ceftazidime (99%). All isolates were susceptible to meropenem. Among the 47 patients with monomicrobial S. marcescens bacteremia, the mortality rate within 5 days of onset in patients receiving appropriate empirical antimicrobial therapy was lower than that in patients receiving inappropriate therapy although this difference was not significant (14% vs 28%, p=0.27). Among the patients with cefotaxime-resistant but ceftazidime-susceptible S. marcescens bacteremia treated with ceftazidime, 6 of 7 patients (86%) survived for more than 2 weeks, suggesting the potential effectiveness of ceftazidime in the treatment of cefotaxime-resistant Serratia infections. Further clinical studies are required to delineate the clinical role of ceftazidime therapy for infections caused by S. marcescens with this resistant phenotype.

 



 

Key words:

Bacteremia, cefotaxime, drug resistance, Serratia marcescens



 



 

J Microbiol Immunol Infect 2005;38:350-357.