Serratia plymuthica: a true pathogen in transplant patients
Mohammed Youssef Elshaer
Received: 11 Oct 2019 - Accepted: 01 Dec 2019 - Published: 13 Dec 2019
Domain: Infectious disease
Keywords: Serratia, urinary tract infections, drug resistance
©Mohammed Youssef Elshaer et al. PAMJ - Clinical Medicine (ISSN: 2707-2797). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Mohammed Youssef Elshaer et al. Serratia plymuthica: a true pathogen in transplant patients. PAMJ - Clinical Medicine. 2019;1:57. [doi: 10.11604/pamj-cm.2019.1.57.20617]
Available online at: https://www.clinical-medicine.panafrican-med-journal.com/content/article/1/57/full
Serratia plymuthica: a true pathogen in transplant patients
Mohammed Youssef Elshaer1,&
1Department of Clinical Pathology, Faculty of Medicine, Mansoura, Egypt
Mohammed Youssef Elshaer, Department of Clinical Pathology, Faculty of Medicine, Mansoura, Egypt
A 50-years-old patient admitted for liver transplantation unit at Mansoura Gastroenterology Surgical Center (GISC). Following liver transplantation, the patient had an indwelling urinary catheter for 5 days, presented with fever 38.5oC and suprapubic tenderness. Urine culture was requested. Significant bacterial count 1x105CFU/ml was obtained. Automated identification of bacterial colonies was performed by the Vitek 2 system. An acceptable identification of Serratia plymuthica was reported. The isolated organism was resistant to almost all the antibiotics tested by AST-GN222 cards, except for Minocycline. The patient was treated with Minocycline, clinical resolution of the infection was obtained after 10-days treatment period.
Urinary tract infections caused by serratia species usually affect those receiving broad spectrum antibiotics or undergoing invasive procedures such as urinary catheterization or surgery. Serratia plymuthica is an infrequent cause of infection in human. This report describes a liver transplant patient with catheter associated urinary tract infection (CAUTI) caused by S. plymuthica. To our knowledge this is the first reported case of Serratia plymuthica in Egypt.
A 50-years-old patient admitted for liver transplantation unit at Mansoura Gastroenterology Surgical Center (GISC). Following liver transplantation, the patient was transferred to transplant Intensive Care Unit (ICU). The patient had an indwelling urinary catheter for 5 days, presented with fever 38.5oC and suprapubic tenderness. Urine examination was ordered. Urine examination revealed pus cells over 100/HPF and RBCS between 10-15/HPF. Urine culture was requested and collected using standard sterile procedures. Significant bacterial count 1x105CFU/ml was obtained. Lactose Fermenter (LF) colonies were observed on MacConkey agar. Automated identification of bacterial colonies was performed by Vitek 2 system. Vitek GN-ID cards were automatically filled with the standardized suspension, sealed, and incubated at 38.5oC, and optical density were measured by the device every 15 minutes. Final results were analyzed and reported by Vitek 2 software within 18 hours. An acceptable identification of Serratia plymuthica was reported with 87% probability. Antibiotic sensitivity was done by AST-GN222 cards and the following AB sensitivity profile was obtained (Table 1).
Ethical consideration: a written informed consent for publication of their clinical details was obtained from the patient.
Serratia species have been considered as important causes of infections, especially in debilitated patients. Several studies suggest that most of the Serratia UTIs are caused by S. marcescens with a high incidence of multiple drug resistance . The majority of patients with Serratia UTIs have a history of recent surgery or instrumentation of the urinary tract . S. plymuthica is found in the soil and has been isolated from different types of food. In 1985, Clark and Janda first reported the isolation of S. plymuthica from a human specimen, when the organism was recovered from a culture from a wound culture of an 8-month-old boy . The first documented case of S. plymuthica infection in humans occurred in 1987, S plymuthica was isolated from blood cultures and a central venous catheter tip culture from a 54-year-old patient with cirrhosis . S. plymuthica was also reported by Carrero et al. in six cases. Three of them were recovered from blood cultures; two were from surgical wound exudates, and one from peritoneal fluid. Almost all the cases were nosocomial in nature since all the patients developed infection few days after admission .
Few sporadic cases of S. plymuthica were isolated from a case of chronic osteomyelitis, lower respiratory infection, three cases of nosocomial septicemia associated with central venous catheter [6-8]. Pascual et al., have isolated S. plymuthica from a patient with necrotic cellulitis, which resolved after appropriate antibiotic treatment surgical exploration and debridement . Isolated cases of septic pseudarthrosis, septic shock and CAPD peritonitis were also reported [10-12]. On reviewing the previously published studies worldwide, only one case of S. plymuthica causing UTIs was reported in an old patient with BPH and the isolate was susceptible to amoxicillin clavulanic acid, imipenem, cefotaxime, ceftazidime, gentamicin, amikacin, ciprofloxacin, nalidixic acid, but resistant to ampicillin . On the contrary, the isolated organism in our study was resistant to almost all the antibiotics tested, except for Minocycline. The patient was treated with minocycline. Clinical resolution of the infection was obtained after 10-days treatment period.
In conclusion, S. plymuthica have been infrequently isolated from clinical specimens, however it should be kept in consideration as serious multidrug-resistant pathogen especially in immunocompromised patients.
The author declares no competing interests.
The authors have read and agreed to the final manuscript.
Table 1: antibiotic sensitivity by Vitek 2 AST-GN222
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