Infección por Serratia marcescens: una inusual causa de lesiones cutáneas / Serratia marcescens infection: an unusual cause of skin lesions

Serratia marcescens corresponde a un bacilo gram negativo, miembro de la familia Enterobacteriaceae. Este microorganismo tiene una alta capacidad de supervivencia en condiciones hostiles y ha sido implicado en infecciones del tracto respiratorio, vía urinaria, meningitis, endocarditis y sistema musculoesquelético. No obstante, es considerado una causa rara de infecciones cutáneas. Esta última tiene distintas presentaciones clínicas, la más frecuente es fascitis necrotizante seguida de celulitis. Los nódulos, las pápulas después de inyecciones de rellenos, las erupciones papulares diseminadas, las placas eritematosas, las pústulas y las úlceras son parte del amplio espectro de formas clínicas descritas en la literatura. Presentamos el caso de una paciente de 50 años, con historia de compromiso del estado general, lesiones cutáneas polimorfas y fiebre. Se confirmó una infección cutánea por Serratia marcescens mediante cultivos. Se destaca el polimorfismo y la coexistencia de distintas manifestaciones en una misma paciente, incluyendo celulitis, nódulo, ulceras y necrosis cutánea y la importancia del estudio microbiológico para el adecuado tratamiento antibiótico.

Serratia marcescens corresponds to gram negative bacillus, a member of the Enterobacteriaceae family. This microorganism has a high survival capacity in hostile conditions and has been implicated in respiratory tract, urinary tract, meningitis, endocarditis and musculoskeletal system infections. However, it is considered a infrequent cause of cutaneous infections. Has different clinical presentations, the most frequent is necrotizing fasciitis followed by cellulite. Nodules, papules after filler injections, disseminated papular eruption, erythematous plaques, pustules and ulcers are part of the broad spectrum of clinical forms described in the literature. We present the case of a 50 year old patient with a history of compromised general condition, polymorphic cutaneous lesions and fever. Serratia marcescens cutaneous infection was confirmed by cultures. The polymorphism and the coexistence of different manifestations in the same patient, including cellulitis, nodule, ulcers and skin necrosis, and the importance of the microbiological study for the adequate antibiotic treatment are highlighted.

Enfermedad granulomatosa crónica: infecciones múltiples como forma de presentación. Caso clínico pediátrico / Chronic granulomatous disease: multiple infections as clinical presentation. Pediatric case report

La enfermedad granulomatosa crónica es una inmunodeficiencia primaria infrecuente, debida a un defecto en la actividad microbicida de los fagocitos, originada por mutaciones en los genes que codifican alguna de las subunidades del complejo enzimático nicotinamida adenina dinucleótido fosfato oxidasa. La incidencia estimada es 1 en 250 000 recién nacidos vivos. Puede presentarse desde la infancia hasta la adultez, por lo general, en menores de 2 años. Las infecciones bacterianas y fúngicas, en conjunto con las lesiones granulomatosas, son las manifestaciones más habituales de la enfermedad. Los microorganismos aislados más frecuentemente son Aspergillus spp., Staphylococcus aureus, Serratia marcescens, Nocardia spp. Se reporta el caso clínico de un varón de 1 año de vida en el que se diagnosticó enfermedad granulomatosa crónica a partir de infecciones múltiples que ocurrieron simultáneamente: aspergilosis pulmonar invasiva, osteomielitis por Serratia marcescens y granuloma cervical por Enterobacter cloacae.

Chronic granulomatous disease is an uncommon primary immunodeficiency due to a defect of the killing activity of phagocytes, caused by mutations in any of the genes encoding subunits of the superoxide-generating phagocyte NADPH oxidase system. The incidence is 1 in 250 000 live births. It can occur from infancy to adulthood, usually in children under 2 years. Bacterial and fungal infections in association with granuloma lesions are the most common manifestations of the disease. Aspergillus species, Staphylococcus aureus, Serratia marcescens, Nocardia species are the most common microorganisms isolated. We describe here a case of a 1-year-old boy with chronic granulomatous disease and invasive pulmonary aspergillosis, Serratia marcescens osteomyelitis and Enterobacter cloacae cervical granuloma.

Draft genome sequence of a GES-5-producing Serratia marcescens isolated in southern Brazil

Abstract Serratia marcescens is a Gram-negative rod intrinsically resistant to polymyxins and usually associated with wound, respiratory and urinary tract infections. The whole genome of the first GES-5-producing S. marcescens isolated from a Brazilian patient was sequenced using Ion Torrent PGM System. Besides blaGES-5, we were able to identify genes encoding for other β-lactamases, for aminoglycoside modifying enzymes and for an efflux pump to tetracyclines.

Brote por Serratia marcescens en una Unidad de Cuidados Intensivos Neonatales: Guayaquil-Ecuador / Serratia marcescens outbreak in Neonatal Intensive Care Unit: Guayaquil, Ecuador

We report a Serratia marcescens outbreak occurred in the NICU of a pediatric hospital in Guayaquil, Ecuador. Nine cases of infection were detected, from which septicemia was developed in 55.5%. The index case was a newborn derived from another institution with septic arthritis caused by the outbreak strain. The infection rate was 17.6% and mortality rate was 33.3%. All isolates were resistant to aminoglycosides and susceptible to third generation cephalosporins and carbapenems. Clonality analysis by pulsed-field gel electrophoresis (PFGE) revealed the presence of two closely related clones confirming the horizontal spread. Measures were taken by the committee such as: strengthening the hand hygiene, patient hygiene and cohort studies of gastrointestinal colonization, which allowed the control of the outbreak.

Comunicamos un brote nosocomial por Serratia marcescens en una Unidad de Cuidados Intensivos en un hospital pediátrico de Guayaquil, Ecuador. Se detectaron nueve casos de infección, manifestándose en 55,5% de los casos como sepsis. El caso índice correspondió a un neonato derivado de otra institución con artritis séptica. La tasa de ataque fue 17,6% (n: 51) y la mortalidad 33,3%. Todos los aislados presentaron resistencia a las cefalosporinas y aminoglucósidos y sensibilidad a carbapenémicos. El análisis de clonalidad reveló la presencia de dos clones estrechamente relacionados, confirmando la diseminación horizontal. Las medidas de control de brote fueron: reforzamiento de higiene de manos, cohorte de los pacientes y búsqueda de colonización gastrointestinal.

Caracterización clínica y epidemiológica de brote a Serratia marcescens en una Unidad de Cuidado Intensivo Pediátrico Hospital Nacional de Itaugua. Paraguay. Abril a setiembre 2015 / Clinical and epidemiological characterization of an outbreak of Serratia marcescens in a Pediatric Intensive Care Unit National Hospital of Itaugua. Paraguay. April to September 2015

Introducción: Serratia marcescens, bacilo Gram negativo, familia enterobacteriaceae; se encuentra en la flora intestinal del hombre y animales, en el medio ambiente y en reservorios como agua, cañerías, llaves, en insumos hospitalarios como jabones y antisépticos. Objetivos: determinar la presencia de un brote, localizaciones, comorbilidades presentes; serotipo del agente causal, cortar la cadena de transmisión. Metodología: estudio descriptivo de un brote epidémico por S. marcescens en el periodo comprendido entre 27 de Abril del 2015 a 19 de Junio del 2015. Se definió como caso a cualquier paciente con cultivo positivo para S. marcescens durante el período epidémico, ya que no se había identificado ningún cultivo positivo para esta bacteria con dicha resistencia en los años previos de vigilancia. Hipótesis: Transmisión por contacto, mano portada. Resultados durante el período epidémico se identificaron 5 pacientes con cultivos positivos para S. marcescens. Las comorbilidades fueron, choque séptico de origen enteral 1/5, cardiopatía/ bronquiolitis 1/5, pos operado de hemorragia ventricular 1/5, oclusión intestinal/ sepsis neonatal tardia1/5. Con procedimientos invasivos tales como, asistencia respiratoria mecánica, catéter venoso central, catéter urinario 5/5, cirugía 2/5, catéter de derivación externa 1/5, antibiótico de amplio espectro con 2 o más asociaciones 4/5, promedio de 43 DDI. Localizaciones: S. Traqueal 3/5, PC 2/5, liq. Peritoneal, HMC 1/5. Tasa de ataque 9.4%(5/53), letalidad 60%(3/5) Intervenciones: precauciones de contacto, cohorte, higiene hospitalaria. Conclusiones: brote a Serratia marcescens, productora de carbapenemasa, detectada mediante vigilancia activa en UCIP, más frecuentemente aislado en S. traqueal y PC. Se controló con medidas de prevención y control.

Introduction: Serratia marcescens, Gram negative bacillus, family enterobacteriaceae; Is found in the intestinal flora of man and animals, in the environment and in reservoirs such as water, pipes, keys, in hospital supplies such as soaps and antiseptics. Objectives: to determine the presence of an outbreak, localizations, present comorbidities; Serotype of the causative agent, cut the transmission chain. Methodology: a descriptive study of an outbreak of S. marcescens in the period from April 27, 2015 to June 19, 2015. Any patient with positive culture for S. marcescens during the epidemic period was defined as the case, since No positive culture for this bacterium had been identified with such resistance in previous years of surveillance. Hypothesis: Transmission by contact, hand cover. Results: 5 patients with S. marcescens positive cultures were identified during the epidemic period. Comorbidities were septic shock of enteral origin 1/5, heart disease / bronchiolitis 1/5, postoperative of ventricular hemorrhage 1/5, intestinal occlusion / late neonatal sepsis1 / 5. With invasive procedures such as mechanical ventilation, central venous catheter, urinary catheter 5/5, surgery 2/5, external lead catheter 1/5, broad spectrum antibiotic with 2 or more associations 4/5, average of 43 DDI . Locations: S. Traqueal 3/5, PC 2/5, liq. Peritoneal, HMC 1/5. Attack rate 9.4% (5/53), lethality 60% (3/5) Interventions: contact precautions, cohort, hospital hygiene. Conclusions: outbreak of Serratia marcescens, a producer of carbapenemase, detected by active surveillance in PICU, most frequently isolated in S. tracheal and PC. It was controlled with prevention and control measures.

Brote de infección nosocomial por Serratia marcescens asociado a contaminación intrínseca de clorhexidina acuosa / Outbreak due to Serratia marcescens associated with intrinsic contamination of aqueous chlorhexidine

Serratia marcescens is a widely distributed gram-negative rod, often associated to nosocomial infections. Some outbreaks linked to contaminated antiseptic solutions have been reported. In this study we report a nosocomial outbreak of surgical site infection and catheter insertion site infection due to S. marcescens. 33 patients with positive cultures were studied after an index case was identified. Epidemiological, microbiological and molecular analysis demostrated an intrinsic contamination of alcohol free chlorhexidine solution as causal factor. Positive cultures were associated with 13 clinical infections, 9 colonized patients, 6 pseudobacteremia episodes and 5 patients without documented exposure. Hospital and national recall of contaminated chlorhexidine solution was performed after this study. Intrinsic contamination of antiseptic solutions is an infrequent cause of nosocomial infections with major epidemiological relevance.

Serratia marcescens es un bacilo gramnegativo de amplia distribución, frecuentemente asociado a infecciones nosocomiales. Se han descrito brotes asociados a la contaminación de diversas soluciones antisépticas. Describimos a continuación un brote de infección de sitio operatorio (ISO) y de infección de sitio de inserción de catéter vascular (ISC) por S. marcescens. A raíz de un caso índice se estudió un total de 33 pacientes con cultivo positivo para S. marcescens. El análisis epidemiológico, microbiológico y molecular logró demostrar la contaminación intrínseca de un lote de clorhexidina acuosa, como fuente común de exposición. Las muestras positivas correspondieron a 13 infecciones clínicas, nueve colonizaciones, seis pseudo-bacteriemias y cinco pacientes sin exposición demostrada. Los resultados de este estudio determinaron el retiro del producto de la institución y posteriormente a nivel nacional. La contaminación intrínseca de antisépticos es una causa poco frecuente de brotes de infecciones nosocomiales cuya identificación posee un gran impacto epidemiológico.

Determinantes do envelhecimento ativo segundo a qualidade de vida e gênero / Determinants of active aging according to quality of life and gender

Resumo Os objetivos deste estudo foram construir um indicador de envelhecimento ativo e testar sua associação com qualidade de vida e possíveis determinantes segundo gênero. O estudo AGEQOL (Aging, Gender and Quality of Life) entrevistou 2052 indivíduos com 60 anos e mais de idade residentes em Sete Lagoas, MG, Brasil. A associação entre envelhecimento ativo, qualidade de vida e possíveis determinantes foi realizada por meio da regressão logística múltipla, com nível de 5% de significância estatística, separadamente para cada gênero. A maioria dos homens pertenceu ao grupo com envelhecimento ativo (58,0%), enquanto 51,8% das mulheres foram alocadas no grupo com envelhecimento normal (p < 0,001). A qualidade de vida nos domínios Físico, Psicológico e Escore total mantiveram-se associada ao desfecho no modelo final para ambos os gêneros. Entre os homens, os fatores comportamentais e participação comunitária foram preditores positivos para envelhecimento ativo. Mulheres com maior renda, que não sofreram quedas e com participação comunitária tiveram maior chance de pertencer ao grupo com envelhecimento ativo. Conclui-se que qualidade de vida e a participação em grupos são os principais determinantes de envelhecimento ativo, e que os demais fatores determinantes associados são diferentes para cada gênero.

Abstract The scope of this study was to construct an indicator of active aging and assess its association with quality of life and possible determinants according to gender. The AGEQOL (Aging, Gender and Quality of Life) study was used to interview 2052 individuals aged 60 years and older residing in Sete Lagoas in the State of Minas Gerais. The association between active aging, quality of life and possible determinants was performed by multiple logistic regression with a 5% level of statistical significance separately for each gender. Most men were in the active aging group (58%), and 51.8% of women were in the normal aging group (p < 0.001). The quality of life in the Physical, Psychological, and total Score domains remained associated with the outcome in the final model for both genders. Among the men, the behavioral and community participation factors were positive predictors of active aging. Women with higher incomes, who did not suffer falls and engaged in community participation, had a better chance of belonging to the active aging group. The conclusion drawn is that quality of life and participation in groups are the main determinants of active aging, and the other factors associated with active aging are different for each gender.

Enhanced production of prodigiosin by Serratia marcescens MO-1 using ram horn peptone

This work addresses the production of prodigiosin from ram horn peptone (RHP) using MO-1, a local isolate in submerged culture. First, a novel gram-negative and rod-shaped bacterial strain, MO-1, was isolated from the body of the grasshopper (Poecilemon tauricola Ramme 1951), which was collected from pesticide-contaminated fields. Sequence analysis of 16S rDNA classified the microbe as Serratia marcescens. The substrate utilization potential (BIOLOG) and fatty acid methyl ester profile (FAME) of S. marcescens were also determined. The effect of RHP on the production of prodigiosin by S. marcescens MO-1 was investigated, and the results showed that RHP supplementation promoted the growth of MO-1 and increased the production of prodigiosin. A concentration of 0.4% (w/v) RHP resulted in the greatest yield of prodigiosin (277.74 mg/L) after 48 h when mannitol was used as the sole source of carbon. The pigment yield was also influenced by the types of carbon sources and peptones. As a result, RHP was demonstrated to be a suitable substrate for prodigiosin production. These results revealed that prodigiosin could be produced efficiently by S. marcescens using RHP.

Gene expression analysis of the SdeAB multidrug efflux pump in antibiotic-resistant clinical isolates of Serratia marcescens.

Purpose: Many isolates of Serratia marcescens, a well-known opportunistic pathogen, can be multidrug resistant. Fluoroquinolones are among the most important groups of antibiotics used for treatment of these organisms. However, fluoroquinolone resistance among S. marcescens isolates is fast increasing. Drug extrusion through efflux pumps like SdeAB/ HasF is one of the major mechanisms of resistance to fluoroquinolones. This study was carried out to analyze, through gene expression analysis of sdeB, the relative contribution of this mechanism toward fluoroquinolone resistance in clinical isolates of Serratia. Materials and Methods: Total RNA from 45 clinical isolates of S. marcescens was isolated. Quantitative real-time RT PCR was performed on the extracted RNA to study the gene expression of sdeB and was normalized to the sdeB expression in the standard strain of S. marcescens. Results: Of the 45 isolates analyzed, sdeB expression was found to be elevated in 20 isolates (44%). Of these 20 isolates, eight (40%) were fully resistant to at least one of the fluoroquinolones studied. Conversely, of the 20 isolates that over-expressed sdeB, 12 (60%) were fully sensitive to all fluoroquinolones tested. Conclusions: Drug efflux pumps are an important means of fluoroquinolone resistance among clinically important species ofSerratia. The expression of these pumps can be up-regulated in the presence of antibiotics and have the potential for changing the phenotype from sensitive to resistant, thus contributing to therapeutic failures.

A case of community-acquired Acinetobacter junii-johnsonii cellulitis / Celulitis por Acinetobacter junii-johnsonii adquirida en la comunidad: una presentación de caso

Acinetobacter skin and soft tissue infection outside of the traumatic wound setting are rare occurrences. The majority of cases occur in the presence of significant comorbilities and by Acinetobacter baumanii. Herein a case is reported of community-onset, health-care-associated, non-traumatic cellulitis caused by Acinetobacter, species junii-johnsonii with bacteremia. This is the first reported case of Acinetobacter junii-johnsonii skin and soft tissue infection. Hemorrhagic bullae might be one of the clinical features of Acinetobacter cellulitis.

La infección de piel y tejidos blandos por Acinetobacter no relacionada con trauma es una presentación inusual. La mayoría de los casos descritos presentan enfermedades concomitantes y son causados por Acinetobacter baumanii. Se describe un caso de celulitis no traumática por A. junii-johnsonii con bacteriemia, de inicio en la comunidad y asociado con el tratamiento médico. De acuerdo con nuestro conocimiento, éste sería el primer caso reportado de infección de tejidos blandos y piel por A. junii-johnsonii. La vesícula hemorrágica podría ser una característica clínica de celulitis por Acinetobacter.

Zygomycetes from herbivore dung in the ecological reserve of Dois Irmãos, Northeast Brazil

Thirty-eight taxa of Zygomycetes distributed in 15 genera were recorded from tapir (Tapirus terrestris), camel (Camelus bactrianus), horse (Equus caballus), deer (Cervus elaphus), agouti (Dasyprocta aguti), donkey (Equus asinus), llama (Llama glama) and waterbuck (Kobus ellipsiprymnus) dung collected at the Reserva Ecológica de Dois Irmãos located in Recife, State of Pernambuco, Northeast Brazil. The samples were collected on a monthly basis from June 2005 to May 2006, taken to the laboratory and incubated in moist chambers. Higher number of taxa was observed in the excrements of tapir, followed by deer and donkey. The highest number of species was detected for Mucor, followed by Pilobolus. Statistical analyses showed significant differences in richness of Zygomycetes taxa between the herbivore dung types. Differences of species composition, however, were weak. Seasonality influenced the Zygomycetes species composition but not its richness. Variations in taxa composition between ruminants and non-ruminants dung were non significant.

Characterization and comparison of Serratia marcescens isolated from edible cactus and from silkworm for virulence potential and chitosan susceptibility

Representative strains of Serratia marcescens from an edible cactus plant and silkworms were characterized and a comparison based on their cellular fatty acid composition, 16S rRNA and groE gene sequence analysis as well as silkworm virulence and chitosan susceptibility was carried out. Results from this study indicate that there are no significant differences between the phenotypic and molecular characterization, virulence and chitosan susceptibility of the S. marcescens strains from the cactus plant and silkworms. Silkworms inoculated with S. marcescens from either plant or silkworm resulted in nearly 100 percent mortality. Chitosan solution exhibited strong antibacterial activity against S. marcescens. This activity increased with the increase of chitosan concentration and incubation time regardless of the strain source. Also, the results indicate that the plant associated S. marcescens maybe plays a possible role in the contamination of humans and animals, in particular silkworms, while chitosan showed a potential to control the contamination caused by S. marcescens.

Outbreak of neonatal infection by an endemic clone of Serratia marcescens / Surto de infecção neonatal a partir de clone endêmico de Serratia marcescens

INTRODUCTION: The outbreak occurred between February and June 2006 and included identification of the cases, analysis of medical records, cultures from environmental sources, resistance analyses and genotyping profile of Serratia marcescens. METHODS: The cultures were composed of 13 blood isolates, 17 rectal and hand swabs and air sampling. RESULTS: The data obtained by pulsed-field gel electrophoresis exhibited three strains that contaminated 24 patients. Systemic infection was the most common in neonates with lower weight, long periods of hospitalization, premature delivery and the use of mechanical ventilation. CONCLUSIONS: This investigation revealed the multifactorial nature of the outbreak. An endemic clone of S. marcescens was detected.

INTRODUÇÃO: O surto ocorreu entre fevereiro a junho de 2006 e incluiu identificação de casos, análise dos prontuários, culturas ambientais, análise de resistência e genotipagem dos isolados de Serratia marcescens. MÉTODOS: Os cultivos foram compostos de 13 isolados de sangue e 17 swabs de reto e mãos e amostras do ar. RESULTADOS: Os dados obtidos por eletroforese de campo pulsado evidenciaram três cepas que contaminaram 24 pacientes. Infecção sistêmica foi mais comum em neonatos com menor peso, longo tempo de internação, nascimento prematuro e uso de respiração mecânica. CONCLUSÕES: Foi evidenciada a natureza multifatorial do surto. Foi encontrado um clone endêmico de S. marcescens.

Corneal Perforation with Preseptal Cellulitis in a Patient with Acute Lymphocytic Leukemia

We report a case of corneal perforation with preseptal cellulitis in a patient with acute lymphocytic leukemia (ALL). A 17-yr-old female patient who was undergoing combination chemotherapy for ALL was referred due to upper lid swelling and pain in the right eye for 2 days. Visual acuity in the right eye was 20/20. Initial examination showed no abnormal findings, other than swelling of the right upper eyelid. Computed tomography showed a finding of preseptal cellulitis. Microbiologic study of bloody and purulent discharge revealed Serratia marcescens. Corneal melting and perforation with iris prolapse were detected in the right eye on the 16th day. Emergent tectonic keratoplasty was performed. Seven months after surgery, visual acuity in the right eye was 20/300, and the corneal graft was stable.

Microbiological evaluation of different antiseptic povidone-iodine and chlorhexidine formulations after intentional contamination of containers / Evaluación microbiológica de las diferentes formulaciones antisépticas, polivinil-pirrolidona-yodo y clorexidina, después de la contaminación intencional de los recipientes / Avaliação microbiológica das diferentes formulações anti-sépticas, polivinilpirrolidona-iodo e clorexidina, após contaminação intencional das almotolias

This study aimed to evaluate the survival rate of microorganisms within different antiseptic formulations - povidone-iodine (PVP-I) and chlorhexidine (CHX) - after intentional contamination, and to establish the minimum care necessary to ensure sterilization of non-disposable antiseptic solution containers. A laboratory study was performed with 180 antiseptic containers, which were contaminated with Serratia marcescens [1 x 105 UFC/mL]. The containers were closed and stored, at room temperature, during seven days and shaken daily. The antiseptic cultures were evaluated to be 100 percent negative to Serratia marcescens in all of the non-disposable containers. These results suggested that antiseptic solutions inactivate microorganisms [1 x 105 UFC/mL]. Since cleaned antiseptic containers have around 102 UFC coming from tap water, it can be inferred that cleansing is a safe minimum procedure to ensure reuse of containers for distribution of CHX and PVP-I solutions in aqueous, detergent and alcoholic formulations.

Los objetivos de este estudio fueron evaluar la sobre vivencia de los micro organismos en las diferentes formulaciones de los antisépticos clorexidina (CHX) y polivinil-pirrolidona-yodo (PVP-Y), después de una contaminación intencional de los recipientes y extrapolar los resultados de los laboratorios para el cuidado mínimo a ser dispensado a los recipientes de múltiple uso para el envase de los antisépticos probados. Para esto, fue desarrollado un estudio de laboratorio, en que 180 recipientes fueron contaminados con 1 x 105 UFC/mL de suspensión conteniendo S.marcescens. Después de la contaminación, seis diferentes formulaciones de antisépticos (clorexidina y PVP-Y en los vehículos alcohólico, detergente y acuoso) fueron distribuidos y sometidos a la cultura diaria durante siete días, a fin de verificar se hubo crecimiento del microorganismo. Los resultados de esta investigación permiten recomendar la limpieza como el procedimiento mínimo en el procesamiento de esos recipientes que garantiza la seguridad de su utilización repetida para distribución de los antisépticos que fueron sometidos a prueba - CHX y PVP-Y.

Os objetivos deste estudo foram: avaliação da sobrevivência dos microrganismos nas diferentes formulações dos anti-sépticos clorexidina (CHX) e polivinilpirrolidona-iodo (PVP-I), após contaminação intencional das almotolias, e extrapolar os resultados laboratoriais para o cuidado mínimo a ser dispensado às almotolias de múltiplo uso para o envase dos anti-sépticos testados. Para tanto, foi desenvolvido estudo laboratorial, em que 180 almotolias foram contaminadas com 1 x 105 UFC/mL de suspensão, contendo S.marcescens. Após a contaminação, seis diferentes formulações de anti-sépticos (clorexidina e PVP-I nos veículos alcoólico, degermante e aquoso) foram distribuídas e submetidas à cultura diária durante sete dias, a fim de verificar se houve crescimento do microrganismo. Os resultados desta investigação permitem a recomendação de que a limpeza como procedimento mínimo no processamento desses recipientes garante a segurança de sua utilização repetida para distribuição dos anti-sépticos testados - CHX e PVP-I.

Spondylodiscitis associated with recurrent Serratia bacteremia due to a transjugular intrahepatic portosystemic shunt (TIPS): a case report

We report a case of spondylodiscitis caused by multiresistant Serratia marcescens in a cirrhotic patient who had several Serratia bacteremias after the placement of a transjugular intrahepatic portosystemic shunt (TIPS) device. We concluded that an endovascular stent that can not be removed makes management of recurrent bacteremia difficult. Furthermore, back pain due to bacteremia is indicative of spondylodiscitis. Serratia marcescens can be an aggressive pathogen, causing spinal infection.

Fascitis necrosante grave por Serratia marcescens: Reporte de un caso clínico / Fatal necrotizing fasciitis due to Serratia marcescens

Una paciente de 81 años con insuficiencia cardíaca crónica, fibrilación auricular y tratamiento anticoagulante, ingresó por un cuadro fulminante de dolor y celulitis en la extremidad inferior derecha de 24 horas de evolución. Sobre la zona existía una úlcera crónica de cinco meses de evolución, manejada con curaciones locales. Al ingreso, había una placa necrótica pero sin hipotensión o confusión mental. La paciente estaba febril y con taquicardia (126 por min). La evaluación reveló ausencia de leucocitosis, trombosis venosa profunda en la misma pierna e infiltrados radiológicos pulmonares en el lóbulo inferior izquierdo. En las horas siguientes aumentó el dolor, apareció secreción purulenta por la úlcera y la paciente presentó confusión, hipotensión, falla respiratoria y luego shock. La paciente recibió ciprofloxacino endovenoso y clindamicina y fue intervenida a las 15 horas de ingreso, efectuándose una amputación supracondílea. El sondeo cardíaco demostró un gasto bajo (2,3 L/min) y una resistencia vascular sistémica (2888 din.s.cm"5) y presión capilar pulmonar elevada (17 cm H(2)0), cifras compatibles con un shock cardiogénico. Evolucionó en malas condiciones y falleció de falla orgánica múltiple a las 36 horas de ingreso. Los hemocultivos demostraron crecimiento de Serratia marcescens en dos frascos. No se efectuó una necropsia y los cultivos de la secreción de la úlcera fueron negativos.

An 81 year old female patient with chronic heart failure and atrial fibrillation receiving anticoagulant therapy, was admitted with progressive pain on her right leg for the past 24 hours, associated to local erythema, edema and warmth. The lesion evolved at the same site where she presented a chronic ulcer for the previous 5 months managed only with local care. At admission a necrotic plaque on the affected site was perceived; there was no hypotension or mental confusion but signs of a deep venous thrombosis on the involved leg were found. She was febrile (37.8°C) and with tachychardia (126 per minute). Laboratory evaluation revealed normal white blood cell count and a subtherapheutic anticoagulant INR value. A chest x-ray showed infiltrates on the left lower lung lobe. On the following hours the lesion evolved with increasing pain, haemorrhagic bullae and a purulent discharge through the ulcer, with the patient developing mental deterioration, hypotension, respiratory failure and shock. The patient received intravenous ciprofloxacin and clindamycin and was operated 15 hours after admission performing an over-the knee amputation. A cardiac catheterization demonstrated a low cardiac output (2.3 L/min), and both a high systemic vascular resistance (2888 din.s.cm"5) and pulmonary capillary wedge pressure (17 cm H(2)0), results compatible with cardiogenic shock. Evolution was progressively worse and she died of multiple organic failure 36 hours after admission. Two blood culture samples grew Serratia marcescens. No necropsy was performed and cultures taken from the leg remained negative.

Bacteriological evaluation of conjunctiva, contact lens storage cases and solutions during contact lens wear.

A total of 90 subjects were investigated in this study, out of which 51 constituted the contact lens wearing group and 39 constituted the control group who had never worn contact lenses. Out of 51 contact lens wearing group, 41 were asymptomatic lens wearer subjects and 10 were symptomatic lens wearer subjects having some complications. All the subjects of contact lens wearing group had worn soft contact lenses on daily wear basis for a duration of 7 days to one year. In total 33 subjects were culture positive and remaining 57 culture negative. Staphylococcus epidermidis was isolated equally from asymptomatic and control group, however, significantly more gram negative organisms such as Pseudomonas aeruginosa and Serratia marcescens were isolated from the symptomatic lens wearers. P. aeruginosa and S. marcescens could also be isolated from lens storage cases. S. marcescens was the organism most commonly isolated from the contact lens solutions. Further, the results showed that both P. aeruginosa and S. marcescens adhere to injured cornea only and not to normal cornea when microscopic study of adherence of bacteria to uninjured and injured ex vivo mouse corneas was done.