How Do You Get Infected With Serratia
You can get infected with Serratia marcescens through contact with contaminated hospital equipment and direct contact with infected people or objects

Serratia marcescens (S. marcescens) is a member of the Enterobacteriaceae family commonly found in water, soil, animals, insects, and plants. Serratia marcescens is an opportunistic pathogen that is primarily responsible for hospital-related infections. 

You can get infected with Serratia marcescens through:

  • Contact with contaminated hospital equipment, such as catheters
  • Direct contact through infected people
  • Sharing or using clothes, utensils, and furniture that carry the bacteria (fomites can spread Serratia)
  • Handling infected coins, countertops, crops, or meat 
The exact source of the contamination of Serratia marcescens cannot be determined. However, it is suspected that the contaminated hands of healthcare professionals are a key mode of transmission. Cross-transmission via transient contamination of hands was identified as the primary source of infection spread.

What are risk factors for Serratia infection?

You may be at higher risk of Serratia infection if you:

  • Have been hospitalized or admitted to an intensive care unit (ICU), especially a neonatal intensive care unit (NICU)
  • Are severely immunocompromised or critically ill 

The most common risk factors for Serratia infection in infants are

  • Extended duration of hospitalization
  • Immaturity of the immune system
  • Low birth weight (less than 1,500 grams) in preterm newborns

This type of infection is often seen in developing countries, and the chances of an outbreak are highest in those areas. Serratia species is the third most common pathogen implicated in neonatal facility outbreaks, accounting for 15% of all cases of infections in hospital settings.

What are the signs and symptoms of Serratia infections?

Serratia infection symptoms depend on the localization of the infection and its spread. Serratia marcescens can cause infections in several areas of the body, including the eyes, urinary tract, and respiratory system. The bloodstream is the most common location of the infection, followed by the respiratory apparatus and the gastrointestinal tract.

If an infected hand touches certain body parts and natural immunity cannot combat the colonization of the pathogen, it can lead to symptoms such as:

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What are treatment options for Serratia infections?

S. marcescens thrives in poor living situations and when combined with antibiotic resistance, easily infects malnourished, old, very young, and chronically ill people. 

Most cases of Serratia infection are treated with antibiotics. Natural immunity can keep Serratia infection under control in healthy people.

Treatment options for Serratia infections may include:

  • Home therapy
    • Clinically stable people can choose to isolate themselves at home. If a person has minor symptoms, hydration and rest are advised.
    • Until the body can fight off the infection, symptomatic therapy along with over-the-counter drugs may be recommended.
  • Antibiotic therapy
    • Serratia can be drug-resistant, so a consultation with an expert in infectious diseases may be advised. Many antibiotics are inherently ineffective against Serratia, and the infection has historically been treated with several medicines to eradicate the strain. Unfortunately, the strain has become more resistant due to the abuse of several drugs.
    • A combination of different antibiotics may help treat S. marcescens infection:
      • Maxipime (cefepime)
      • Broad-spectrum beta-lactam or beta-lactamase inhibitor combinations
      • Quinolones
    • A combination of an aminoglycoside and an antipseudomonal beta-lactam should be used to treat the infection. Amikacin can be used to treat most strains. Quinolones are also quite effective against most strains.
  • Surgery
    • Surgical drainage may be required for purulent collections (abscesses).
    • Abscesses may require surgical drainage as well as antibiotic treatment.
    • Because multiresistant strains are widespread, definitive therapy should be based on susceptibility testing results.

How can you prevent Serratia infections?

Prevention is still the best way to tackle this disease. Once S. marcescens has colonized a surface, eradication may be challenging. The following are the most effective techniques to prevent the spread of S. marcescens:

  • Regular cleaning
    • Thoroughly and regularly clean all surfaces using a bleach-based cleaner or disinfectant.
    • Kitchen and bathroom surfaces, as well as other locations exposed to water, are higher-risk areas that must be cleaned more frequently.
  • Disinfection
    • Full disinfection and rinsing are necessary on surfaces where the pink slime associated with S. marcescens has already grown. To adequately disinfect S. marcescens, chlorine bleach products are necessary.
    • Disinfectants should be allowed to sit on the surface for 20 minutes before being thoroughly rinsed with clean water.
    • Avoid scratching surfaces
    • Do not scratch any surfaces with abrasives when cleaning for S. marcescens. Scratches can provide a favorable breeding environment for the bacteria.
  • Proper sterilization and sanitation
    • Equipment used in a hospital environment should be autoclave-treated.
    • All food and water sources should be monitored regularly for bacterial contamination. Avoid unintended contact by ensuring that all equipment, food, and water are properly sterilized and sanitized.
    • Disinfectants, especially phenolic disinfectants (1% sodium hypochlorite, 70% ethanol) or formaldehyde, are effective against S. marcescens and can successfully prevent residue from accumulating on surfaces.
  • Hand hygiene and isolation
    • Hand hygiene and isolating sick neonates are standard techniques to control and interrupt ongoing epidemics. Early identification of infected individuals, as well as rapid implementation of infection control measures, strict hand hygiene, and contact restrictions, are critical to limiting infection transmission.
  • Hospital staff training
    • The Healthcare Infection Control Practices Advisory Committee and Centers for Disease Control and Prevention recommendations emphasize the significance of a coordinated multidisciplinary approach to managing hospital infections. Staff training, environmental sampling, isolation of colonized people, infection control measures, and understanding the significance of cross-contamination are examples of such preventive measures.

S. marcescens can promote fast-spreading epidemics that result in neonatal infections. If S. marcescens is isolated from clinical specimens, infection control measures and epidemiologic investigations should be implemented as soon as possible.

Prevention is essential because it is difficult to treat infections caused by S. marcescens. This is especially true in hospitals where S. marcescens is a known concern. To prevent S. marcescens from forming and infecting people, hospitals must maintain appropriate cleaning and disinfection of equipment and facilities. 

Early detection of colonized or infected individuals, as well as prompt deployment of infection control measures, are critical to limiting the spread of S. marcescens.

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Medically Reviewed on 11/9/2022
References
Image Source: iStock image

Serratia marcescens. http://www.antimicrobe.org/b26.asp

Serratia marcescens. https://www.microbiologyresearch.org/content/journal/jmm/10.1099/00222615-46-11-903?crawler=true

Serratia Marcescens: Biochemical Characteristics, Antimicrobial Sensitivity And Clinical Significance. http://www.mjpath.org.my/past_issue/MJP1981/serratia-marcescens.pdf