Serratia marcescens is an enteric pathogen that is more likely to infect relatively immunocompromised hosts. Brain abscesses are relatively uncommon infections in neonates but when they occur are usually due to infections with gram-negative organisms. We report a case of a brain abscess due to S. marcescens in a very low birth weight (VLBW) neonate. The patient was one of triplets born at 30 wk gestation with a birth weight of 1,450 g. Cranial ultrasound during the first week of life was normal. On the 25th day of life, increased apnea, bradycardia, feeding intolerance, and lethargy occurred, followed by a generalized seizure. Laboratory evaluation revealed anemia, neutropenia, and thrombocytopenia. Cultures of blood and CSF yielded S.marcescens. Head CT scan demonstrated multiple brain abscesses. MRI showed bilateral cerebral cystic changes, and fluid samples from the right cystic structure grew S.marcescens with different sensitivities than the initial CSF cultures. The patient was initially treated with tobramycin and cefotaxime, and a week later cefotaxime was switched to cefipime; the cefipime was discontinued after 3 weeks of treatment. Meropenem was continued for 3 weeks after the first negative culture, after the second culture of S. marcescens was found from the brain abscess. The patient was transferred to a local hospice after failing to respond to treatment. We conclude that development of brain abscesses should be considered and screened for in very low birth weight neonates with S. marcescens meningitis.
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