Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients
Yıl: 2022 Cilt: 16 Sayı: 3 Sayfa Aralığı: 173 - 178 Metin Dili: İngilizce DOI: 10.5578/ced.20229755 İndeks Tarihi: 06-05-2023
Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients
Öz: 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 Türkiye. 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 before 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.
Anahtar Kelime: Çocuk Hastalarda Serratia marcescens Bakteriyemisi: Yüksek Oranda ESBL ve Karbapenemaz Üretimi
Öz: Giriş: Bu çalışmanın amacı, 20 aylık bir dönem içerisinde kan kültüründe Serratia marcescens üreyen hastalarda beklenmedik bir artış olması ile bu hastaların demografik, klinik ve laboratuvar sonuçlarının incelenme- si, mortaliteye yol açan özelliklerin ve dirençli suşlara tedavi yaklaşımının gözden geçirilmesidir. Gereç ve Yöntemler: Kan kültüründe S. marcescens üreyen ve bakte- riyemi ile uyumlu klinik bulguları olan hastalar geriye dönük olarak in- celenmiştir. Yaş, cinsiyet, altta yatan hastalıklar, beyaz küre ve nötrofil sayıları, C-reaktif protein (CRP) ve albümin düzeyleri, hastanede yatış süresi, yoğun bakımda yatış süresi, santral venöz kateter varlığı ve süresi, 28-gün mortalitesi ve antibiyogram kaydedildi. Enfeksiyonlar kan yayım veya kateter ilişkili kan yayım enfeksiyonu olarak ayrıldı. Antimikrobiyal direnci değerlendirmek için suşlar non-MDR, MDR, XDR ve PDR olarak sınıflandırıldı. Bulgular: Hastaların 12 (%26.9)’sinin altta yatan hastalığı maligniteydi. Ortalama hastanede kalış süresi 42.7 ± 41.4 (3-171) gündü. Kan yayım enfeksiyonları sırasında 43 hastada kemo-portlar ve Hickman kateterleri dahil santral venöz kateterler mevcuttu. Yirmi dört hastada kan yayım enfeksiyonu, 21 hastada kateterle ilişkili kan yayım enfeksiyonu mevcuttu. Kateterle ilişkili kan yayım enfeksiyonu öncesi santral venöz katete- rin mevcut kalış süresi 46.02 ± 50.96 (1-200) gündü. Bakteriyemi atakları sırasında 24 kateter (%55.8) çekildi. Dört hasta (%8.9) bakteriyemi atağı sırasında kaybedildi. Kaybedilen hastaların laboratuvar bulguları şöyley- di; ortalama WBC 17.200/mm³; ortalama serum CRP seviyesi 147.2 mg/L idi; ortalama serum albümin düzeyi 2.43 g/dL idi. Tüm üremeler arasında S. marcescens izolatlarının %57.8’i ESBL, %40’ı ise karbapenemaz üreti- yordu. Bu izolatlar MDR olmayan (%42.2), MDR (%31.1), XDR (%24.4) ve PDR (%2.2) olarak sınıflandırıldı. XDR izolatları için kullanılan en yaygın antimikrobiyal rejimler yüksek doz uzun süreli meropenem, amikasin, le- vofloksasin ve tigesiklindi. Sonuç: S. marcescens önemli nozokomiyal etkenlerden biridir ve gide- rek artan direnç paterni bildirilmektedir. S. marcescens’in polimiksinlere doğal dirençli olması ve bu çalışmada da saptandığı üzere ESBL ve kar- bapenemaz üretiminin artışı endişe vericidir. Tedavi başarısızlığı ve ölüm yüksek doz ve erken dönemde kateter çekilmesi ile azaltılabilir.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Ballot DE, Bandini R. Nana T, Bosman N, Thomas T, Davies VA, et al. A review of -multidrug-resistant Enterobacteriaceae in a neonatal unit in Johannesburg, South Africa. BMC Pediatr 19(1):320. [CrossRef]
- 2. Roshenthal VD, Belkebir S, Zand F, Afeef M, Tanzi VL, Al-Abdely HM, et al. Six-year multicenter study on short-term peripheral venous cathe- ters-related bloodstream infection rates in 246 intensive units of 83 hospitals in 52 cities of 14 countries of Middle East: Bahrain, Egypt, Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Pakistan, Palestine, Sudan, Tunisia, Turkey, and United Arab Emirates-Internatio- nal Nosocomial Infection Control Consortium (INICC) findings. J Infect Public Health 2020;13(8):1134-41. [CrossRef]
- 3. Bard JD, Hindler JF, Lewinski MA. Carbapenemase-Producing Ser- ratia marcescens: The treatment Conundrum. Clin Microbiol Newsl 2010;32:77-8. [CrossRef]
- 4. Batah R, Loucif L, Olaitan AO, Boutefnouchet N, Allag H, Rolain JM. Outbreak of Serratia marcescens coproducing ArmA and CTX-M-15 me- diated high levels of resistance to aminoglycoside and extended-spe- ctrum beta-lactamases, Algeria. Microb Drug Resist 2015;21:470-6. [CrossRef]
- 5. Xu Q, Fu Y, Zhao F, Jiang Y, Yu Y. Molecular characterization of carbape- nem-resistant Serratia marcescens clinical isolates in a tertiary hospital in Hangzhou, China. Infection and Drug Resistance 2020:13:999-1008. [CrossRef]
- 6. Yu WL, Lin CW, Wang DY. Serratia marcescens bacteremia: Clinical fe- atures and antimicrobial susceptibilities of the isolates. J Microbiol Im- munol Infect 1998;31:171-9.
- 7. Kim SB, Jeon YD, Kim JH, Kim JK, Ann HW, Choi H, et al. Risk factors for mortality in patients with Serratia marcescens bacteremia Yonsei Med J 2015;56:348-54. [CrossRef]
- 8. Shih HI, Lee HC, Lee NY, Chang CM, Wu CJ, Wang RL, et al. Serra- tia marcescens bacteremia at a medical center in southern Taiwan: High prevalence of cefotaxime resistance. J Microbiol Immunol Infect 2005;38:350-7.
- 9. Mermel LA, Allon M, Bouza E, Flynn P, O’Grady NP, Raad II, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases So- ciety of America. Clin Infect Dis 2009;49:1-45. [CrossRef]
- 10. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections 1988. Am J Infect Control 1988;16:128-40. [CrossRef]
- 11. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care associated bloodstream infections in adults:a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002;137:791-7. [CrossRef]
- 12. World Health Organization. International statistical classification of diseases and related health problems. WHO; 2019. Available from: htt- ps://icd.who.int/browse10/2019/en#/
- 13. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Expert rules in antimicrobial susceptibility testing. Available from: ht- tps://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Ex- pert_Rules/2020/ExpertRules_V3.2_20190515_Enterobacterales.pdf (Accessed date:May, 2020).
- 14. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameter. Ava- ilable from: https://www.eucast.org/fileadmin/src/media/PDFs/EU- CAST_files/Disk_criteria/Validation_2020/Enterobacterales_v_8.0_Ja- nuary_2020. www.eucast.org/clinical_breakpoints.
- 15. Clinical and Laboratory Standard Institute (CLSI). Performance Stan- dards for Antimicrobial Susceptibility Testing; 29 th. CLSI supplement M100. Wayne, PA:CLSI;2019.
- 16. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-re- sistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268- 81. [CrossRef]
- 17. Nordmann P, Naas T, Poirel L. Global spread of Carbapenemase-produ- cing Enterobacteriaceae. Emerg Infect Dis 2011;17:1791-8. [CrossRef]
- 18. Choi SH, Kim YS, Chung JW, Kim TH, Choo EJ, Kim MN, et al. Serratia bacteremia in a large university hospital: Trends in antibiotic resistance during 10 years and implications for antibiotic use. Infect Control Hosp Epidemiol 2002;23:740-7. [CrossRef]
- 19. Cheng KC, Chuang YC, Wu LT, Huang GC, Yu WL. Clinical experiences of the infections caused by extended-spectrum β-lactamase-produ- cing Serratia marcescens at a medical center in Taiwan. Jpn J Infect Dis 2006:59;147-52.
- 20. Bouchillon S, Badal R, Dowzicky M, Hackel M, Hawser S, Hoban D. An- tibiotic Profile of 55 Carbapenem-Resistant Serratia marcescens (CRS- m)-TEST Program.
- 21. Souli M, Karaiskos I, Masgala A, Galani L, Barmpouti E. Double carba- penem combination as salvage therapy for untreatable infections by KPC-2-producing Klebsiella pneumoniae. Eur J Clin Microbiol Infect Dis 2017;36:1305-15. [CrossRef]
- 22. Pettit RS, Neu N, Cies JJ, Lapin C, Muhlebach MS, Novak KJ, et al. Po- pulation pharmacokinetics of meropenem administered as a prolon- ged infusion in children with cystic fibrosis. J Antimicrob Chemother 2016;71:189-95. [CrossRef]
- 23. Cies JJ, Moore WS, Calaman S, Brown M, Narayan P, Parker J, et all. Pharmacokinetics of continuous infusion meropenem for the treat- ment of Serratia marcescens ventriculitis in a pediatric patient. Phar- macotherapy 2015;35:32-6. [CrossRef]
- 24. Shabaan AE, Nour I, Elsayed Eldegla H, Nasef N, Shouman B, Ab - del-Hady. Conventional versus prolonged infusion of meropenem in neonates with gram-negative late-onset sepsis: A randomized control- led trial. Pediatr Infect Dis J 2017;36:358-63. [CrossRef]
- 25. Fisher RG. Serratia, In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ (eds), Feigin and Cherry‘s Textbook of Pediatric Infectious Dise- ases, 8th ed, Philadelphia: Elsevier; 2019:1064-6.
- 26. Yu Z, Pang X, Wu X, Shan C, Jiang S. Clinical outcomes of prolonged infusion (extended infusion or continuous infusion) versus intermittent bolus of meropenem in severe infection: A meta-analysis. PLoS One 2018;13(7):e0201667. [CrossRef]
| APA | Erat T, Özdemir H, yahsi a, Tural Kara T, azapağası e, KENDIRLI T, ince e, Atasay B, Cabı Ünal E, Aysev A, ince e, Çiftçi E (2022). Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients. , 173 - 178. 10.5578/ced.20229755 |
| Chicago | Erat Tuğba,Özdemir Halil,yahsi aysun,Tural Kara Tuğçe,azapağası ebru,KENDIRLI TANIL,ince elif,Atasay Begüm,Cabı Ünal Emel,Aysev Ahmet Derya,ince erdal,Çiftçi Ergin Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients. (2022): 173 - 178. 10.5578/ced.20229755 |
| MLA | Erat Tuğba,Özdemir Halil,yahsi aysun,Tural Kara Tuğçe,azapağası ebru,KENDIRLI TANIL,ince elif,Atasay Begüm,Cabı Ünal Emel,Aysev Ahmet Derya,ince erdal,Çiftçi Ergin Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients. , 2022, ss.173 - 178. 10.5578/ced.20229755 |
| AMA | Erat T,Özdemir H,yahsi a,Tural Kara T,azapağası e,KENDIRLI T,ince e,Atasay B,Cabı Ünal E,Aysev A,ince e,Çiftçi E Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients. . 2022; 173 - 178. 10.5578/ced.20229755 |
| Vancouver | Erat T,Özdemir H,yahsi a,Tural Kara T,azapağası e,KENDIRLI T,ince e,Atasay B,Cabı Ünal E,Aysev A,ince e,Çiftçi E Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients. . 2022; 173 - 178. 10.5578/ced.20229755 |
| IEEE | Erat T,Özdemir H,yahsi a,Tural Kara T,azapağası e,KENDIRLI T,ince e,Atasay B,Cabı Ünal E,Aysev A,ince e,Çiftçi E "Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients." , ss.173 - 178, 2022. 10.5578/ced.20229755 |
| ISNAD | Erat, Tuğba vd. "Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients". (2022), 173-178. https://doi.org/10.5578/ced.20229755 |
| APA | Erat T, Özdemir H, yahsi a, Tural Kara T, azapağası e, KENDIRLI T, ince e, Atasay B, Cabı Ünal E, Aysev A, ince e, Çiftçi E (2022). Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients. Çocuk Enfeksiyon Dergisi, 16(3), 173 - 178. 10.5578/ced.20229755 |
| Chicago | Erat Tuğba,Özdemir Halil,yahsi aysun,Tural Kara Tuğçe,azapağası ebru,KENDIRLI TANIL,ince elif,Atasay Begüm,Cabı Ünal Emel,Aysev Ahmet Derya,ince erdal,Çiftçi Ergin Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients. Çocuk Enfeksiyon Dergisi 16, no.3 (2022): 173 - 178. 10.5578/ced.20229755 |
| MLA | Erat Tuğba,Özdemir Halil,yahsi aysun,Tural Kara Tuğçe,azapağası ebru,KENDIRLI TANIL,ince elif,Atasay Begüm,Cabı Ünal Emel,Aysev Ahmet Derya,ince erdal,Çiftçi Ergin Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients. Çocuk Enfeksiyon Dergisi, vol.16, no.3, 2022, ss.173 - 178. 10.5578/ced.20229755 |
| AMA | Erat T,Özdemir H,yahsi a,Tural Kara T,azapağası e,KENDIRLI T,ince e,Atasay B,Cabı Ünal E,Aysev A,ince e,Çiftçi E Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients. Çocuk Enfeksiyon Dergisi. 2022; 16(3): 173 - 178. 10.5578/ced.20229755 |
| Vancouver | Erat T,Özdemir H,yahsi a,Tural Kara T,azapağası e,KENDIRLI T,ince e,Atasay B,Cabı Ünal E,Aysev A,ince e,Çiftçi E Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients. Çocuk Enfeksiyon Dergisi. 2022; 16(3): 173 - 178. 10.5578/ced.20229755 |
| IEEE | Erat T,Özdemir H,yahsi a,Tural Kara T,azapağası e,KENDIRLI T,ince e,Atasay B,Cabı Ünal E,Aysev A,ince e,Çiftçi E "Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients." Çocuk Enfeksiyon Dergisi, 16, ss.173 - 178, 2022. 10.5578/ced.20229755 |
| ISNAD | Erat, Tuğba vd. "Bloodstream Infections Caused by Serratia marcescens: Have a High Prevalence of ESBL and Carbapenemase Production in Pediatric Patients". Çocuk Enfeksiyon Dergisi 16/3 (2022), 173-178. https://doi.org/10.5578/ced.20229755 |
