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. 2025 Sep 9;25(1):1105.
doi: 10.1186/s12879-025-11569-z.

Epidemiology, resistance profiles, and risk factors of multidrug- and carbapenem-resistant Serratia marcescens infections: a retrospective study of 242 cases

Hong Zhu #  1 , Fengyan Li #  2 , Xiaoli Cao  2 , Yan Zhang  2 , Chang Liu  2 , Yuxin Chen  3 , Han Shen  4
Affiliations

Epidemiology, resistance profiles, and risk factors of multidrug- and carbapenem-resistant Serratia marcescens infections: a retrospective study of 242 cases

Hong Zhu et al. BMC Infect Dis. .

Abstract

Background: Serratia marcescens is an opportunistic pathogen increasingly associated with healthcare-associated infections and rising antimicrobial resistance. The emergence of multidrug-resistant (MDR) and carbapenem-resistant S. marcescens (CRSM) presents significant therapeutic challenges. However, data on the clinical and microbiological analyses of these infections remain limited.

Methods: This retrospective study included 242 hospitalized patients with S. marcescens infections admitted to Nanjing Drum Tower Hospital, China, from January 2012 to December 2020. Clinical characteristics, antimicrobial susceptibility profiles, and resistance patterns were analyzed. Patients were categorized based on infection site (urinary tract infection [UTI] vs. bloodstream infection [BSI]) and resistance phenotype (MDR and CRSM). Antimicrobial susceptibility testing (AST) was performed according to CLSI 2024 guidelines. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors associated with BSI, UTI, and CRSM.

Results: MDR isolates exhibited significantly lower susceptibility to β-lactams, aminoglycosides, and fluoroquinolones compared to non-MDR isolates, although amikacin and sulfamethoxazole retained moderate activity. Isolates from blood samples showed higher susceptibility to most antibiotics than urinary isolates, particularly imipenem (23.5% vs. 3.2%). Multivariate analysis identified prior hospitalization as an independent risk factor for S. marcescens BSI (OR = 2.8, P = 0.048), while kidney disease (OR = 4.2, P < 0.001) was independently associated with UTIs. Pulmonary infection (OR = 3.2, P = 0.020) and prior exposure to ≥ 3 antibiotic classes (OR = 3.7, P = 0.031) were independent predictors of carbapenem-resistant infections. Patients with MDR bacteremia had a markedly higher 28-day mortality (50.0%) than non-MDR cases (12.0%). The 28-day mortality rate for CRSM infections was 28.6%.

Conclusion: This study reveals substantial differences in antimicrobial susceptibility between MDR and non-MDR S. marcescens isolates and highlights amikacin and sulfamethoxazole as potential treatment options against MDR strains. Didentified clinical risk factors-including prior hospitalization, kidney disease, and extensive antibiotic exposure-underscore the importance of early risk stratification and optimized antibiotic stewardship.

Keywords: Serratia marcescens; Bloodstream infection; Carbapenem resistance; Multidrug resistance; Risk factors; Urinary tract infection.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki, approved by the ethics committee (2021 − 363) and the need to obtain signed informed consent was waived due to the absence of any intervention. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

References

    1. McCarlie SJ, et al. The hormetic effect observed for Benzalkonium chloride and Didecyldimethylammonium chloride in Serratia sp. HRI. Microorganisms. 2023. 10.3390/microorganisms11030564. - PMC - PubMed
    1. Maina JW, et al. Multidrug-resistant gram-negative bacterial infections and associated factors in a Kenyan intensive care unit: a cross-sectional study. Ann Clin Microbiol Antimicrob. 2023;22(1):85. - PMC - PubMed
    1. Tang B, et al. Detection of clinical Serratia marcescens isolates carrying bla(KPC-2) in a hospital in China. Heliyon. 2024;10(8): e29702. - PMC - PubMed
    1. Zhong Y et al. Occurrence of Serratiamarcescens Carrying bla(IMP-26) and mcr-9 in Southern China: New Insights in the Evolution of Megaplasmid IMP-26. Antibiotics (Basel), 2022;11(7). 10.3390/antibiotics11070869. - PMC - PubMed
    1. Liang Q, et al. Active surveillance of carbapenem-resistant gram-negative bacteria to guide antibiotic therapy: a single-center prospective observational study. Antimicrob Resist Infect Control. 2022;11(1):89. - PMC - PubMed

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