Chorioamnionitis caused by Serratia marcescens in a healthcare worker: A case report

Abstract

BACKGROUND

Healthcare workers (HCWs) are at an increased risk for exposure to infections. Serratia marcescens (S. marcescens) is a gram-negative, opportunistic and nosocomial pathogen belonging to the Enterobacterieae family. A few case reports have been published of chorioamnionitis caused by S. marcescens infection. Immunological changes during pregnancy can also affect the risk of infection. However, few studies have examined hospital-acquired bacterial infection in pregnant HCWs.

CASE SUMMARY

A 33-year-old woman, a resident in anesthesiology, was admitted at 14 wk gestation for fever with chills. She had no medical history other than contact dermatitis of both hands that started from the beginning of the trainee. There was no obvious infection focus and no bacterial growth in blood cultures. She was discharged after 1 wk of empirical antibiotic treatment. At three weeks before the fever started, she had a blister on the site of contact dermatitis on both hands, she applied antibiotic ointment for three days and the blisters had healed. At 19 wk gestation, she had a high fever and was readmitted. Physical examination and image studies were nonspecific and the patient had no other symptoms. S. marcescens grew in blood cultures at 19 wk gestation. Treatment with intravenous antibiotics was started. However, she suffered a miscarriage at 22^4/7 wk gestation. Pathologically, the amniotic membrane showed chorioamnionitis with a focal infarct. Subsequently, a placenta tissue culture grew S. marcescens.

CONCLUSION

HCWs can be exposed to pathogens that can cause opportunistic infections such as S. marcescens. Pregnancy affects the immune system, making it susceptible to opportunistic infections. Therefore, pregnant HCWs may require more preventive measures, including hand hygiene and avoid risk factors (ex. wrapping the skin).

Keywords: Serratia marcescens; Chorioamnionitis; Healthcare workers; Pregnancy; Case report

Core Tip: In this case, a 33-year-old female patient suffered a miscarriage due to chorioamnionitis caused by Serratia marcescens infection. Although she performed aseptic procedures and hand hygiene during medical practice, it is suspected that the cause of the infection was the weakening of the skin line due to contact dermatitis. In addition, it is thought that changes in the immune system caused by pregnancy may also have an effect. Therefore, it is recommended that pregnant healthcare workers perform more meticulous hand hygiene and avoid infection risk factors (ex. wrapping the skin).