Serratia Marcescens Meningitis: Epidemiology, Prognostic Factors and Treatment Outcomes

J Microbiol Immunol Infect. 2013 Aug;46(4):259-65. doi: 10.1016/j.jmii.2012.07.006. Epub 2012 Aug 24.

Abstract

Background/purpose: Serratia marcescens is a rare pathogen of central nervous system infections. This study was to investigate the epidemiology, prognostic factors, and treatment outcomes of S. marcescens meningitis.

Methods: This retrospective analysis included 33 patients with culture-proven S. marcescens meningitis hospitalized between January 2000 and June 2011.

Results: Of the 33 patients enrolled, only one did not receive neurosurgery before the onset of S. marcescens meningitis. Patients with S. marcescens meningitis had higher ratios of brain solid tumors (54.5%) and neurosurgery (97.0%) with a mortality rate of 15.2%. The mean interval between the first neurosurgical procedure and the diagnosis of meningitis was 17.1 days (range, 4-51 days). Only one third-generation cephalosporin-resistant S. marcescens isolate was recovered from the patients' cerebrospinal fluid (CSF) specimens. Compared with the favorable outcome group (n = 20), the unfavorable outcome group (n = 13) had a higher percentage of brain solid tumors, more intensive care unit stays, and higher Sequential Organ Failure Assessment score, CSF lactate and serum C-reactive protein concentrations at diagnosis of meningitis. Under the multiple regression analysis, CSF lactate concentration ≥2-fold the upper limit of normal (ULN) was independently associated with unfavorable outcomes (odds ratio, 7.20; 95% confidence interval, 1.08-47.96; p = 0.041).

Conclusion: S. marcescens meningitis is highly associated with neurosurgical procedures for brain solid tumors. CSF lactate concentration ≥2x ULN may predict an unfavorable outcome. Its mortality is not high and empiric treatment with parenteral third-generation cephalosporins may have a satisfactory clinical response.

Keywords: Lactate; Meningitis; Outcome; Serratia marcescens.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Cephalosporins / therapeutic use
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Meningitis, Bacterial / drug therapy*
  • Meningitis, Bacterial / epidemiology*
  • Meningitis, Bacterial / mortality
  • Meningitis, Bacterial / pathology
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Serratia Infections / drug therapy*
  • Serratia Infections / epidemiology*
  • Serratia Infections / mortality
  • Serratia Infections / pathology
  • Serratia marcescens / isolation & purification*
  • Survival Analysis
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Cephalosporins