Marvelous but morbid: Infective endocarditis due to serratia marcescens

• Type of Material: Article
• Authors: Varun K. Phadke, Emory University; Jesse Jacob, Emory University
• Language: English
• Date: 2016-05-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Wolters Kluwer Health, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1097/IPC.0000000000000360
• Title of Journal or Parent Work: Infectious Diseases in Clinical Practice
• ISSN: 1056-9103
• Volume: 24
• Issue: 3
• Start Page: 143
• End Page: 150
• Grant/Funding Information: Varun K. Phadke is supported by the Emory Vaccinology Training Program, Award Number T32AI074492 from the National Institute of Allergy and Infectious Diseases; Varun K. Phadke is supported by the Emory Vaccinology Training Program, Award Number T32AI074492 from the National Institute of Allergy and Infectious Diseases.
• Keywords: Serratia marcescens; infective endocarditis; AmpC beta-lactamase; intravenous drug use
• Research Categories: Health Sciences, General; Health Sciences, Immunology

Abstract

A 46-year-old man with human immunodeficiency virus infection and active intravenous drug use presented with approximately 2 weeks of fevers and body aches. On physical examination, he was somnolent and had a new systolic murmur, bilateral conjunctival hemorrhages, diffuse petechiae, and left-sided arm weakness. Echocardiography revealed a large mitral valve vegetation, and brain imaging demonstrated numerous embolic infarctions. Blood cultures grew Serratia marcescens. Despite aggressive treatment with meropenem, the patient died due to intracranial hemorrhage complicated by herniation. Serratia marcescens is an uncommon cause of infective endocarditis. While this disease has historically been associated with intravenous drug use, more recent reports suggest that it is now largely a consequence of opportunistic infections of the chronically ill. Our case highlights several characteristic features of this infection, including isolation of a nonpigmented strain of the organism, an antibiotic susceptibility profile suggestive of AmpC β-lactamase production, and rapid clinical deterioration with multiple embolic complications resulting in death. In this review, we discuss the history, epidemiology, and management of endovascular infections due to Serratia species, emphasizing the continued importance of considering this organism in the differential diagnosis of endocarditis among intravenous drug users and as a potential indication for surgical therapy.