Serratia bacteremia in a large university hospital: trends in antibiotic resistance during 10 years and implications for antibiotic use

Infect Control Hosp Epidemiol. 2002 Dec;23(12):740-7. doi: 10.1086/502004.

Abstract

Objective: To identify antibiotic resistance trends and risk factors for resistance of Serratia species to third-generation cephalosporins.

Design: Retrospective survey of medical records.

Setting: A 2,200-bed, tertiary-care hospital.

Patients: One hundred twenty-two patients with Serratia bacteremia between January 1991 and June 2001.

Methods: Infectious disease physicians collected data from medical records regarding patient demographics, underlying disease or condition, portal of entry, microorganism, antibiogram, complications, antibiotics received, and outcome.

Results: Among 122 Serratia isolates, 117 (95.9%) were Serratia marcescens and 110 (90.2%) were of nosocomial origin. During the study period, the 122 isolates showed a high rate of resistance to third-generation cephalosporins (45.9%) and extended-spectrum penicillins (56.6%). The resistance rate to ciprofloxacin was 32.0%. The resistance rate to third-generation cephalosporins increased from 31.7% for 1991 to 1995 to 54.9% for 1996 to 1998 and 50.0% for 1999 to 2001. In the multivariate analysis, prior use of a second-generation cephalosporin (adjusted odds ratio [OR], 5.90; 95% confidence interval [CI90], 1.41 to 24.6; P = .015) or a third-generation cephalosporin (OR, 3.26; CI95, 1.20 to 8.87; P = .020) was a strong independent risk factor for resistance to third-generation cephalosporins. The overall case-fatality rate was 25.4% (Serratia bacteremia-related case-fatality rate, 13.1%).

Conclusion: Prior use of a second- or third-generation cephalosporin was the most important risk factor for bacteremia with Serratia resistant to third-generation cephalosporins, suggesting the need for antibiotic control. The potential role of patient-to-patient spread could not be fully evaluated in this retrospective study.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteremia / drug therapy*
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • Cephalosporins / therapeutic use
  • Child
  • Child, Preschool
  • Cross Infection / drug therapy*
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Drug Resistance, Bacterial*
  • Female
  • Hospitals, University / statistics & numerical data
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Korea / epidemiology
  • Length of Stay
  • Male
  • Middle Aged
  • Morbidity
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Serratia Infections / blood
  • Serratia Infections / drug therapy*
  • Serratia Infections / epidemiology*
  • Serratia Infections / transmission
  • Survival Rate

Substances

  • Cephalosporins