Clinical and microbiological survey of Serratia marcescens infection during HIV disease

Citation
R. Manfredi et al., Clinical and microbiological survey of Serratia marcescens infection during HIV disease, EUR J CL M, 19(4), 2000, pp. 248-253
Citations number
30
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Microbiology
Journal title
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES
ISSN journal
0934-9723 → ACNP
Volume
19
Issue
4
Year of publication
2000
Pages
248 - 253
Database
ISI
SICI code
0934-9723(200004)19:4<248:CAMSOS>2.0.ZU;2-5
Abstract
Clinical charts of 2398 consecutive HIV-infected patients hospitalized over an 8-year period were reviewed retrospectively to identify all cases of Se rratia infection and to evaluate the occurrence and outcome of these cases according to several epidemiological, clinical, and laboratory parameters. Seventeen of 2398 (0.71%) patients developed Serratia marcescens infections : nine had septicaemia, six had pneumonia, one had a lymph node abscess, an d one had cellulitis. All patients were severely immunocompromised, as evid enced by a mean CD4+ lymphocyte count of <70 cells/mu l and a frequent diag nosis of AIDS (13 patients), When compared with other disease localizations , septicaemia was related to a significantly lower CD4+ cell count and a mo re frequent occurrence of neutropaenia. Antibiotic, corticosteroid, or cotr imoxazole treatment was frequently carried out during the month preceding d isease onset. Hospital-acquired Serratia spp, infection was more frequent t han community-acquired infection and was significantly related to AIDS, neu tropaenia, and sepsis. Antimicrobial sensitivity testing showed complete re sistance to ampicillin and cephalothin but elevated susceptibility to ureid openicillins, second- and third-generation cephalosporins, aminoglycosides, quinolones, and cotrimoxazole, An appropriate antimicrobial treatment atta ined clinical and microbiological cure in all cases, in absence of related mortality or relapses. Since only 13 episodes of HIV-associated Serratia sp p. infection have been described until now in nine different reports (7 pat ients with pneumonia, 3 with sepsis, 1 with endophthalmitis. 1 with perifol liculitis, and 1 with cholecystitis), our series represents the largest one dealing with Serratia marcescens infection during HIV disease. Serratia ma rcescens may be responsible for appreciable morbidity among patients with H IV disease, especially when a low CD4+ cell count, neutropaenia, and hospit alization are present. The clinician and the microbiologist facing a severe ly immunocompromised HIV-infected patient with a suspected bacterial diseas e should consider the Serratia spp. organisms. In fact, a rapid diagnosis a nd an adequate and timely treatment can avoid disease relapses and mortalit y.