From the Guidelines
For bacteremia with Serratia involving a permcath in an ESRD patient, the permcath should be removed as soon as possible and replaced with a temporary catheter at a different site if ongoing dialysis access is needed. This approach is based on the guidelines for the management of intravascular catheter-related infections, which recommend removing the catheter in cases of bloodstream infection due to gram-negative bacilli, such as Serratia 1. The management of CVC-related bloodstream infections in patients with tunneled CVCs or implantable devices, such as ports, is crucial, and removal of the catheter is often necessary to prevent complications like septic thrombosis, endocarditis, or osteomyelitis 1. Key considerations in the treatment of Serratia bacteremia include:
- Initiating antibiotic therapy immediately with a combination of a carbapenem or cefepime plus an aminoglycoside, taking into account the patient's ESRD status and adjusting doses accordingly 1
- Treatment duration should be 14 days after catheter removal if uncomplicated, or 4-6 weeks if there are metastatic complications like endocarditis or osteomyelitis 1
- Repeating blood cultures to confirm clearance of bacteremia
- Considering the potential for Serratia to develop resistance during therapy, making catheter removal crucial for successful treatment 1
- Being aware of the increased risk of treatment failure, persistent bacteremia, and mortality associated with delayed catheter removal in ESRD patients 1
From the FDA Drug Label
Cefepime has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections... Gram-negative bacteria ... Serratia marcescens
Gentamicin has been shown to be active against most of the following bacteria, both in vitro and in clinical infections ... Gram-Negative Bacteria ... Serratiaspecies
Gentamicin Injection, USP is indicated in the treatment of serious infections caused by susceptible strains of the following microorganisms: ... Klebsiella-Enterobacter-Serratiaspecies
The answer to the question of bacteremia with Serratia permcath removal in ESRD is that Cefepime and Gentamicin are active against Serratia marcescens.
- Key points:
- Cefepime and Gentamicin have in vitro activity against Serratia marcescens.
- These antibiotics may be considered for the treatment of bacteremia caused by Serratia marcescens in patients with ESRD.
- However, the choice of antibiotic should be based on susceptibility testing and clinical judgment.
- It is essential to follow the recommended dosage and administration guidelines for these antibiotics, especially in patients with renal impairment 2, 3, 3.
From the Research
Bacteremia with Serratia Permcath Removal in ESRD
- There is limited research directly addressing bacteremia with Serratia permcath removal in End-Stage Renal Disease (ESRD) patients.
- However, studies have investigated Serratia infections in various contexts, including bacteremia and endocarditis 4, 5, 6, 7, 8.
- Serratia marcescens is a common pathogen causing hospital-acquired infections, including ocular infections and bacteremia 4.
- Intravenous drug use is a significant risk factor for Serratia bacteremia, with a high proportion of patients hospitalized with Serratia infections being IV drug users 5.
- Antibiotic susceptibility reporting can impact broad-spectrum antibiotic use in Serratia bacteremia, with narrow-spectrum antibiotics being effective in some cases 6.
- Serratia species can cause infective endocarditis, which is associated with high morbidity and mortality, particularly in patients with a history of intravenous drug use 7.
- Combination antibiotic therapy may be associated with improved outcomes in patients with Serratia endocarditis, although larger prospective studies are needed to confirm this 8.