title: Serratia bacteremia in a large university hospital: trends in antibiotic resistance during 10 years and implications for antibiotic use.
abstract: 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.
authors.affiliation: Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Jin-Won
authors.initials: JW
authors.lastname: Chung
authors.forename: Tae Hyong
authors.initials: TH
authors.lastname: Kim
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Choo
authors.forename: Mi-Na
authors.initials: MN
authors.lastname: Kim
authors.forename: Baek-Nam
authors.initials: BN
authors.lastname: Kim
authors.forename: Nam Joong
authors.initials: NJ
authors.lastname: Kim
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Woo
authors.forename: Jiso
authors.initials: J
authors.lastname: Ryu
mesh_terms: 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
chemical_list: D002511:Cephalosporins