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

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.