The role of Serratia marcescens changed from a harmless saprophytic microorganism to an important opportunistic human pathogen. It often causes nosocomial device-associated outbreaks and rarely serious invasive community acquired infections. We present a case of a community-acquired Serratia marcescens bacteremia leading to Respiratory Distress Syndrome in a previously healthy 51-year-old man without identifiable risk factors. Full recovery was achieved with solely medical treatment and observation in ICU during three days. To our knowledge it is an extremely uncommon presentation and just few cases have been previously reported in the literature.Key words: Sepsis, Serratia, respiratory insufficiency, abscess, immunocompetent. CASE REPORTThis gentleman, aged 51, and allergic to penicillin but with no more medical records or previous contacts in the health care system, presented with 2 hours evolution of chills and fever to our hospital. Previously healthy, he was sporty and went regularly to the gym. 48 hours before this episode, he had been suffering from back pain and took NSAIDs. When he arrived to the emergency department his blood pressure was 111/65 mmHg, heart rate 125 bpm and temperature 37.4ºC. Initial examination showed SpO 2 98% on room air, tachycardia and bilateral rhonchus. Labs revealed an increase in creatinine (1.72mg/dL), acute phase reactants (CRP 26.44 mg/L and PCT 14.85 ng/mL) and a WBC count of 3100 (neutrophils rate 80.3%). Chest X-ray, abdominal ultrasound and abdominopelvic CT scan were performed and did not reveal further findings but a small right psoas abscess of about 10-11 mm. The patient then was admitted to the ward, and, after taking blood and urine cultures, started on antibiotics with levofloxacin and metronidazol.8 bottles of two pairs of blood cultures taken from a peripheral vein by percutaneous puncture at admision and 48 hours afterwards (4 on each one) came back all positives for Serratia marcescens. Although ruling out endocarditis on echocardiogram, we interpreted the case as a severe serratia marcescens bacteremia psoas abscess related. Antibiogram guided treatment was performed with i.v. ciprofloxacin and gentamicin and no percutaneous drainage was done due to the small volume of the abscess. Nonetheless, the patient suddenly worsened with tachypnea and respiratory failure in the context of RDS (Figure 1) so he was trans-ferred to the ICU. After 72 hours in which OTI was unnecessary, the patient improved and was sent back to the ward again. He was then put on antibiotics for 3 weeks and has undergone both clinical and radiological improvement. Abdominopelvic CT control scan showed partial resolution of bilateral ground glass areas on the lungs and the psoas abscess. Beyond these 3 weeks of endovenous treatment we decided 10 more days of oral ciprofloxacin due to the severity of the case causing respiratory involvement. Procalcitonin value was 67 ng/mL the day admitted at ICU and 0.4 after 9 days of accurate treatment (4 days prior to discharge). Outpatients clinic fol...

No abstract

No abstract

No abstract

No abstract