Case report
Necrotizing soft tissue infection caused by Serratia marcescens: A case report and literature review

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Abstract

A 64-year-old man with advanced liver cirrhosis was transferred to an emergency center due to septic shock and markedly inflamed left leg. Under a clinical diagnosis of necrotizing soft tissue infection (NSTI), the patient undertook intensive therapy but died 25 h after arrival. The pathogenic organism, Serratia marcescens, was later isolated from blood and soft tissue cultures. NSTI is very rarely associated with S. marcescens. A literature review showed that only 16 such cases, including our case, have been reported to date. Our case is the first evidence of an S. marcescens NSTI in a patient with liver cirrhosis. S. marcescens NSTI has an extremely high mortality rate; total mortality and mortality in cases involving the extremities were 75% (12 of 16 cases) and 83.3% (10 of 12 cases), respectively. Physicians need to be aware that S. marcescens can induce fatal infections in community patients.

Introduction

Serratia marcescens is a gram-negative aerobic bacillus belonging to the family Enterobacteriaceae. The pathogen ubiquitously exists in hospitals and causes blood stream, respiratory, and urinary tract infections [1], [2]. Soft tissue is rarely infected with S. marcescens [3], and the involvement of necrotizing soft tissue infection (NSTI) that yields a fulminant course and high mortality is extremely rare. To our knowledge, only 15 such cases have been described in the English literature to date [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]. We herein describe a fatal case of NSTI caused by S. marcescens along with a literature review.

Section snippets

Case report

A 64-year-old man with a 10-year history of liver cirrhosis due to a hepatitis C virus infection was transferred to our emergency center because of a swollen left leg accompanied by shock. A week prior to the transfer, he had burned his left calf while welding. A blister had formed, but he did not get medical attention and left the burn injury untreated. One day before admission, the left leg started to swell and the patient's general condition rapidly deteriorated.

On arrival, the vital signs

Discussion

S. marcescens rarely causes NSTI and the clinical characteristics of the infection are still unclear. To get a better understanding, we conducted a literature review of previous reports of S. marcescens-induced NSTI from MEDLINE. The most recent review of the disease was performed by Rehman et al. in 2012 [15]. Thereafter, five additional cases have been described [12], [13], [14], [16], [17]. A summary of the previous cases including our case is shown in Table 2.

Although most cases of

Conflict of interest

The authors confirm that there are no conflicts of interests to declare.

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    Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.