Serratia bacteremia in a large university hospital: trends in antibiotic resistance during 10 years and implications for antibiotic use.
OBJECTIVE
To identify antibiotic resistance trends and risk factors for resistance of Serratia species to third-generation cephalosporins.


METHODS
Retrospective survey of medical records.


METHODS
A 2,200-bed, tertiary-care hospital.


METHODS
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%).


CONCLUSIONS
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.
Choi
Sang-Ho
SH
Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Kim
Yang Soo
YS
Chung
Jin-Won
JW
Kim
Tae Hyong
TH
Choo
Eun Ju
EJ
Kim
Mi-Na
MN
Kim
Baek-Nam
BN
Kim
Nam Joong
NJ
Woo
Jun Hee
JH
Ryu
Jiso
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007723:Korea / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016868:Serratia Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology* / Q000635:transmission; D015996:Survival Rate
D002511:Cephalosporins