Abstract: PUB111
Serratia liquefaciens Bacteremia in Two Dialysis Patients
Session Information
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Silberzweig, Jeffrey I., The Rogosin Institute, New York, New York, United States
- Morris, Diane, The Rogosin Institute, New York, New York, United States
- DiRienzo-Lawless, Rachael, The Rogosin Institute, New York, New York, United States
- Reydel, Catherine, The Rogosin Institute, New York, New York, United States
- Waltrous, Clarence L., The Rogosin Institute, New York, New York, United States
Introduction
Serratia are an unusual cause of bacteremia but can present a risk for patients receiving maintenance hemodialysis.
Case Description
Two patients who were sitting proximately receiving maintenance dialysis via central catheters developed chills and fever. Cultures grew E. cloacae; vancomycin and gentamicin were administered. They were hospitalized; cultures grew S liquefaciens. Both recovered with antibiotics and returned without sequelae.
An experienced RN with excellent catheter technique cared for both patients. The only common medication was a multi-dose heparin vial with clear solution. The patients had no relationship outside the facility and neither had evidence of catheter or exit site infection. No other patients had signs of infection.
Discussion
Serratia are water dwelling bacteria which infect humans via environmental sources. Five cases of transfusion-related septic shock were reported between 1992 and 1999; no source was identified1. Ten cases of S. liquefaciens blood stream infection and six pyrogenic reactions at a hemodialysis center in 2001 were found to be related to multiple punctures of single-use vials with pooling of preservative-free Epogen®2. In 2017, two cases of bacteremia were reported among nine patients who underwent myocardial perfusion scanning. Bacteria were found in the saline used to reconstitute the radiopharmaceutical3.
The treatment area including handwashing sinks and water boxes were in good order; no bacteria were identified. Dialysate water cultures were without significant growth. In addition to reviewing catheter care and hand hygiene, we are reviewing proper storage and handling of multidose heparin vials.
Water-borne bacteria are a threat to patients receiving maintenance dialysis. Vigilance must be paid to reduce the risk of infection. The differential diagnosis for bacteremia must be broad and treatment must cover relatively unusual etiologies.