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24 Şubat 2017 Cuma

SERRATIA INFECTIONS -Brief


Serratia are gram-negative bacilli belonging to the enterobacter group. There are at least 15 species. The genus is composed of facultative anaerobic gram-negative rods. It is painted red. The strains obtained from the hospital are usually white-creamy stained and multiply well in standard incubators (35-37 ° C).
S. marcescens and other Serratia species do not secrete too many virulence factors and are considered opportunistic. They are mobile and can become adherents to the cell through the fimbrial exchange. S. marcescens can secrete several different hemolysins that are toxic to different cell types.
Serratia infections in humans are generally acquired from exogenous environment. People do not get infected from animals etc.  serratia are, in general, is directly gained from contacts with sources such as soil or water. Although serratia species are often associated with hospital outbreaks, epidemics outside the hospital are not very common. Outbreaks are defined as contamination of ready-made solutions that must be sterile as a fabrication defect.
Individually, hospital-acquired Serratia infection is not very common. The presence of an invasive device in the patient is an important risk factor for Serratia species acquired from the hospital. However, surveillance data indicate that Serratia is not predominant as device-associated infection pathogens. More often, it is necessary to focus on common resource outbreaks.
S. marcescens is a demonstrated human pathogen that can cause urinary tract infection, pneumonia and bloodstream infections. It may cause infective endocarditis in patients using intravenous drug. Rarely, skin and soft tissue infections, surgical site infections, even necrotizing fasciitis, osteomyelitis, septic arthritis have been described.
CNS infections are usually associated with ventriculoperitoneal shunting, lumbar puncture, or spinal injections. Meningoencephalitis has been reported in newborns.
Serratia species affect the eye more often than other regions. According to some studies, Serratia is the most common cause of hospital-acquired ocular infection following P. aeruginosa. Ocular involvement may be in the form of conjunctivitis, keratoconjunctivitis, corneal ulcers and keratitis. Serratia-induced endophthalmitis is uncommon, but its long-term outcome may be poor.
Serratia species are naturally resistant to ampicillin, amoxicillin, ampicillin-sulbactam, amoxicillin clavulanate. Likewise, it is resistant to narrow spectrum cephalosporins (such as cefazolin), cephamycin, macrolides, tetracyclines and nitrofurantoin. AmpC can also produce broad-spectrum beta-lactam resistance by producing beta lactamase. ESBL production and carbapenemase production are also described.
Serratia species are susceptible to a series of antibiotics such as fluoroquinolones, aminoglycosides, trimotoprim-sulfamethoxazole, piperacillin-tazobactam, ticarcillin-clavulanate, 3rd and 4th generation cephalosporins, aztreonam and carbapenems.

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