Jpn. J. Infect. Dis., 59 (3), 147-152, 2006
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Original Article
Clinical Experiences of the Infections Caused by Extended-Spectrum -Lactamase-Producing Serratia marcescens at a Medical Center in Taiwan
Kuo-Chen Cheng1, Yin-Ching Chuang2, Lii-Tzu Wu3, Guan-Cheng Huang2 and Wen-Liang Yu1,4*
1Department of Intensive Care Medicine and 2Department of Internal Medicine, Chi-Mei Medical Center, Tainan; 3Institute of Medical Science and Department of Microbiology, Chaina Medical University, Taichung; and 4Department of Medicine, Taipei Medical University, Taipei, Taiwan
(Received September 20, 2005. Accepted March 14, 2006)
*Corresponding author: Mailing address: Department of Intensive Care Medicine, Chi-Mei Medical Center, 901 Chung Hwa Rd, 710 Yungkang, Tainan, Taiwan. Tel: +886-6-281-2811 ext. 52605C Fax: +886-6-283-3351, E-mail: yuleon_md@yahoo.com
SUMMARY: CTX-M-3 has become the most common extended-spectrum -lactamase (ESBL) produced by Serratia marcescens in Taiwan. An expanded effort to detect ESBL among 123 nonrepetitive isolates of S. marcescens was made and 15 (12%) ESBL-producers were identified, all revealing CTX-M-3. Without routinely detecting the ESBL for S. marcescens in clinical laboratories, 80% of the ESBL-producers were reported to be susceptible to cefepime. The clinical spectrum of ESBL-producing S. marcescens-related infections included febrile urinary tract infection (n = 3); afebrile pyuria (n = 2); pneumonia (n = 3); spontaneous bacterial peritonitis (n = 3); secondary bacteremia (n = 2) and one each with primary bacteremia and colonization of the central catheter tip. Overall, the 30-day mortality rate was 33.3% (5/15) and the outcome depended on the severity of the underlying disorder and infection per se. In conclusion, although our case numbers were limited, due to the substantial incidence and associated mortality of ESBL-producing S. marcescens and its potential treatment failure by an apparently susceptible cephalosporin, we recommend that the detection and report of ESBL production for S. marcescens in clinical laboratories be made mandatory.