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The Role of Serratia Marcescens Positive Nasal Cultures in Patients with Refractory Chronic Rhinosinusitis

Stewart H. Bernard *, Brittany C. Dobson, Varun V. Varadarajan, Jeb M. Justice

Background: The role of bacteria in Chronic Rhinosinusitis (CRS) as an instigator or propagator of the disease is controversial. There has been a great deal of research into the most commonly isolated bacteria in CRS such as Staphylococcus aureus and Pseudomonas aeruginosa, there has however been little research into the less commonly isolated microbial organisms such as Serratia marcescens.

Methods: A retrospective chart review of patients who demonstrated Serratia marcescens sinus culture or DNA pyrosequencing analysis from August 2013 to December 2016 was conducted. Clinic notes, operative reports, microbiology results, and DNA pyrosequencing results were reviewed for presenting symptoms, interventions, and outcomes.

Results: 29 patients were identified with Serratia marcescens. 26/29 (89.6%) patients had undergone functional endoscopic sinus surgery (FESS) prior to their culture showing Serratia marcescens. 17 of 29 (59%) patients grew polymicrobial culture results in addition to Serratia marcescens, most commonly Pseudomonas aeurginosa (24.1%) and Staphylococcus aureus (24.1%). Combining the culture sensitivities from all 29 patients serratia had sensitivity three orally available antibiotics: levofloxacin (97%), ciprofloxacin (92%), and bactrim (97%).

Conclusions: This is the first literature to examine the characteristics of patients with Serratia Marcescens in sinus disease patients to our knowledge. Serratia marcescens infection in the sinuses may be a post surgical disease, and it appears Levofloxacin, Ciprofloxacin, and TMP/SMX are all oral anti-microbials to which Serratia marcescens is consistently susceptible. The extent to which Serratia Marcescens an instigator of recalcitrant disease or a bystander is unclear at this time and warrants further investigation.