Correspondence

A Rare Case of Serratia Sepsis and Spontaneous Abortion

N Engl J Med 2003; 348:668-669February 13, 2003

Article

To the Editor:

In pregnancy, sepsis is a potentially severe threat to both mother and fetus. We describe a case of Serratia marcescens chorioamnionitis associated with bacteremia and spontaneous abortion.

A 38-year-old woman (gravida 1, para 0) with a 19-week intrauterine pregnancy presented with a history of intermittent fevers (a temperature of up to 103°F [39.4°C]) for three weeks. Her only other symptom before admission was malaise. A physical examination was unremarkable except for an appropriately gravid abdomen. The findings on gynecologic examination were normal and included intact membranes. Laboratory studies revealed a white-cell count of 24,700 per cubic millimeter, with 2 percent bands. Treatment with tobramycin and cefepime was begun when blood cultures revealed gram-negative rods. Blood cultures eventually grew S. marcescens, which was susceptible to tobramycin, trimethoprim–sulfamethoxazole, and cefepime. An exhaustive search for the source of the bacteremia, including ultrasonographic studies of the abdomen and pelvis, two transthoracic echocardiographic studies, magnetic resonance imaging of the brain, sinuses, abdomen, and pelvis, lumbar puncture, and multiple obstetrical ultrasonographic examinations, was negative except for a positive vaginal culture for serratia.

The patient did well in the hospital except for minor vaginal spotting. She was discharged on the 12th hospital day, with plans to complete four weeks of treatment with intravenous tobramycin and cefepime. Because of concern about the toxicity of tobramycin, trimethoprim–sulfamethoxazole was substituted. Unfortunately, her pregnancy ended in spontaneous abortion at 21 weeks of gestation. She recovered from the sepsis. Placental histopathological studies (Figure 1Figure 1Photomicrograph Showing Chorioamnionitis with an Inflammatory Infiltrate and Necrotic Debris (Hematoxylin and Eosin, ×20).) revealed severe acute chorioamnionitis, funisitis, and a small focus of deciduitis; Gram's staining was negative for organisms.

Subsequent colonoscopy and hysteroscopy failed to reveal a source of the serratia. The patient had undergone transcervical chorionic-villus sampling approximately six weeks before the onset of symptoms. Infections are not common after this procedure and usually occur within two weeks.1,2 No other cases of similar serratia infections occurred among the patients of the obstetrician who provided care for this woman or at the hospital where she was treated. She reported no self-instrumentation. She did not undergo amniocentesis.

A previous case report described S. marcescens infection associated with sepsis and spontaneous abortion during pregnancy.3 According to another report, serratia is not part of the normal vaginal flora.4 Although there have been no reports of large series of cases, physicians should be aware of the association between serratia infection and spontaneous abortion.

Brent J. Prosser, M.D.
James Horton, M.D.
Carolinas Medical Center, Charlotte, NC 28232
brentprosser@hotmail.com

4 References

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   Dumont M, Brunet CF, Thoulon JM, Saint-Aroman J, Moulin A. A propos de nouveaux germes pathogènes en obstétrique. Bull Fed Soc Gynecol Obstet Lang Fr 1967;19:457-459
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Citing Articles (2)

Citing Articles

1. 1

   Louis Yi Ann Chai, Mary Rauff, Jeanne Shan Yin Ong, Adrian Chin Leong Kee, Felicia Su Wei Teo. (2011) Serratia septicaemia in pregnancy: Further evidence of altered immune response to severe bacterial infection in pregnancy. Journal of Infection
   CrossRef

2. 2

   Natalie B. Meirowitz, Adiel Fleischer, Michele Powers, Francine Hippolyte. (2006) Diagnosis of Placental Abscess in Association With Recurrent Maternal Bacteremia in a Twin Pregnancy. Obstetrics & Gynecology 107:Supplement, 463-466
   CrossRef