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. Design: Retrospective survey of medical records. Setting: A 2,200-bed, tertiary-care hospital. Patients: 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 [$CI{95}$], 1.41 to 24.6; P = .015) or a third-generation cephalosporin (OR, 3.26;$CI{95}$, 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%). Conclusion: 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 patientto-patient spread could not be fully evaluated in this retrospective study.