Combined serotyping and biotyping of Serratia marcescens

A Microbiologic Approach to the Investigation of Bacterial Nosocomial Infection Outbreaks

This article details the appropriate microbiologic support that is critical to the successful investigation of nosocomial infection problems. The infection control team must have ready access to microbiologic data, and the laboratory should retain epidemiologically relevant bacterial isolates. Investigation of epidemics is facilitated by precise identification of bacteria and careful antibiotic susceptibility testing. In some situations, biotyping, serotyping, phage typing, bacteriocin typing, and other specialized techniques may be required. Plasmid analysis may be useful in the investigation of nosocomial infection problems caused by antibiotic-resistant bacteria.

Re-evaluation of the serotypes of Serratia marcescens and separation into two schemes based on lipopolysaccharide (O) and capsular polysaccharide (K) antigens

Chemical and serological analysis has revealed that many of the 29 O serotype reference strains of Serratia marcescens contain both neutral and acidic polysaccharides which correspond to LPS O antigens and capsular K antigens, respectively. New O and K antigen typing schemes have therefore been devised, based on the known chemical structures of the surface polysaccharides of the organism. These schemes were designed to allow the specific detection of these antigens on unknown strains using ELISAs. O antigens were detected using whole cells cultured in broth then autoclaved to remove capsular material, while K antigens were detected using formolized whole cells which had been cultured on glycerol agar to enhance capsule production. After testing with the 29 reference strains as well as 423 distinct clinical strains, it was apparent that different aspects of chemical structure were associated with different degrees of serological reactivity and the typing schemes were modified further to accommodate this. In general, the O antigen repeating unit structures were chemically simple with di- or trisaccharide backbones. Serological specificity was often provided solely by the presence or absence of an O-acetyl substituent, or a change in the linkage between two sugar residues. Five of the O serotypes in the new scheme were represented by 12 of the 29 reference strains, while three reference strains lacked O antigens altogether, resulting in the elimination of 10 of the original O types. In contrast, the K antigen repeating unit structures were more complex and chemically diverse, having at least four sugar residues. Three K types were each seen in two reference strains while 12 of the 29 reference strains were acapsular. Thus, the resulting schemes contain 19 O types and 14 K types and allow the definitive serotype identification of S. marcescens.

Serratia marcescens infections

The recognition of serratia as an opportunistic human pathogen can be dated from 1959, when the microorganism entered the family ofEnterobacteriaceae,with features recognizable in the clinical laboratory and related to theKlebsiella/Enterobactergroup. Since then, physicians have been challenged to establish the significance of isolation of serratia from a clinical specimen.

Comparison of two methods for bacteriocin typing of Serratia marcescens

Two methods of bacteriocin susceptibility typing for Serratia marcescens were compared. A total of 80 epidemiologically unrelated isolates from patients in a single hospital were typed by the cross-streaking method and the mitomycin C-induced (spotting) method. The cross-streaking method was found to be more discriminatory than the spotting method. Using the cross-streaking method, it was possible to differentiate 50 bacteriocin groups out of the 80 isolates, whereas only 31 groups could be obtained with the spotting method. The reproducibility and percentage typability of the cross-streaking method (82.5 and 93.75%, respectively) were found to be as good as, if not better than, those of the spotting method (78.75 and 90.0%, respectively). Other factors, such as lower economic cost, technical simplicity, and the relative ease in the scoring of results, indicate a preference for the cross-streaking method. The findings of this study support the choice of the cross-streaking method for the bacteriocin typing of S. marcescens in epidemiological studies.

Nosocomial transmission of Serratia marcescens in a veterinary hospital due to contamination by benzalkonium chloride

During a 1-year period, Serratia marcescens was isolated from 50% of all contaminate intravenous catheters from dogs and cats in a large veterinary hospital. S. marcescens was also isolated from respiratory tracts, genitourinary tracts, skin, and other sites in hospitalized animals. A total of 55% of the clinical isolates and 66% of the intravenous catheter isolates had the same API biochemical profile. The source of the S. marcescens was determined to be aqueous benzalkonium chloride (0.025%) sponge pots located in the intensive care unit, surgery rooms, and outpatient clinic areas of the hospital. Of the 11 S. marcescens isolates submitted to the Centers for Disease Control for serotyping (6 from aqueous benzalkonium chloride sponge pots, 5 from intravenous catheters), 8 were identified as serotype O10:H11. All S. marcescens isolates tested for antibiotic susceptibilities were multiply resistant; isolates were most frequently resistant to streptomycin, cephalothin, and ampicillin. This study demonstrates that improper use of disinfectants plays an important role in the nosocomial transmission of S. marcescens.

Use of the API 20E system to identify veterinary Enterobacteriaceae

A total of 503 veterinary enteric bacterial pathogens obtained from state veterinary diagnostic laboratories were tested on API 20E strips to determine whether this rapid microidentification system could be utilized for veterinary clinical microbiology. The API 20E strip accurately identified 96% of the veterinary isolates and misidentified 3%. Identifications by the API system and the diagnostic laboratories were in agreement in 85% of the isolates, disagreement on 16% of the isolates, and 1% were not identified by the API strip. Differences in identification occurred primarily in distinguishing between Klebsiella and Enterobacter and between Enterobacter and Escherichia coli. These disagreements were most often due to incorrect identifications by the diagnostic laboratory rather than by the API system. Biotype differences between human and veterinary isolates were compared. Significant differences were noted in several biochemical reactions. The main differences observed for E. coli isolates were in ornithine decarboxylase production and melibiose fermentation. The largest differences for Salmonella occurred in arginine dihydrolase production, citrate utilization, and inositol fermentation, whereas for Klebsiella pneumoniae the main differences were noted in urease production and nitrate reduction. These biotype differences, however, did not affect the accurate identification of organisms on the API strip.

Seroepidemiology of clinical isolates of Klebsiella in Connecticut

The distribution of capsular serotypes of 200 clinical isolates of Klebsiella pneumoniae and Klebsiella oxytoca from four Connecticut hospitals was determined. Serotyping was done by an indirect fluorescent-antibody technique. Hospitals included three community hospitals from the Hartford area and one university hospital in New Haven. During the test period, epidemiological surveillance did not detect any nosocomial epidemic involving Klebsiella species. Ninety-two percent of the isolates were typable. Of the 72 possible serotypes, 62 were represented among these strains. Forty-two percent of the typable strains were distributed among 10 serotypes. The predominant serotypes were types 31, 22, and 18 representing 19% of the typable strains (8, 6, and 5%, respectively). No one particular serotype was associated exclusively with a specific site of infection.

Serotyping of Serratia marcescens: current status of seven recently described flagellar (H) antigens

The slightly revised, current scheme of 20 flagellar (H) antigens of Serratia marcesens was examined. The seven new H antigens were demonstrated to be antigenically distinct as determined with Le Minor's H-immobilization test. The H-immobilization antibodies of rabbit anti-H immune sera proved resistant to treatment with 2-mercaptoethanol and dithiothreitol, respectively. On the other hand, dual absorptions of rabbit anti-H immune sera with killed cells of Staphylococcus aureus strain Cowan I, i.e., protein A, failed to reduce significantly H-immobilization titers of rabbit sera, although human immunoglobulins G and M were bound by protein A. It was tentatively concluded that the 2-mercaptoethanol- and dithiothreitol-refractory H-immobilizing rabbit antibodies belonged to the immunoglublin M class. H-antigen (phase) variation was not demonstrable in several extramural, clinical isolates of S. marcescens for which this phenomenon had been claimed. Rather, four of these six isolates were found to consist of cell populations of two distinct serotypes, as also borne out by bacteriocin typing; the flagellar H-antigens of the remaining two isolates were stable, with minor, hterologous H-antigen cross-reactivity.

Reproducibility of an indirect immunofluorescent-antibody technique for capsular serotyping of Klebsiella pneumoniae

Reproducibility of capsular serotypes of 55 consecutive clinical isolates of Klebsiella pneumoniae was evaluated by an indirect immunofluorescent-antibody technique previously described by Riser et al. (J. Clin. Pathol. 29: 296-304, 1976) Five colonies per specimen were examined for colony-to-colony variation, day-to-day variation, and reader-to-reader variation. Seventy-two reference strains were tested with each of 18 pools and 72 specific antisera prior to the clinical specimens to determine antiserum specificity and cross-reaction patterns. Lot-to-lot variation was examined with the reference strains. There was minimal lot-to-lot variation among the antisera tested. Ten antiserum pools required supplementation with individual antisera. The patterns of supplementation may vary from lot to lot. Colony-to-colony variation in intensity of immunofluorescence occurred, but there was no variation in serotype. These findings differ from previously reported colonial variation which occurred when API 20E biotypes were determined for individual colonies of K. pneumoniae directly from clinical specimens. Eighteen percent of clinical isolates studied gave cross-reactions when tested with the indicated specific antiserum. All but one of the cross-reactions were resolved with further dilutions. Day-to-day and reader-to-reader variations were minimal. The immunofluorescent-antibody technique is a reliable and reproducible method for capsular serotype determination. Capsular serotypes are less variable than API biotypes since colony-to-colony variation of serotype does not occur.

Standardization of the Analytab Enteric (API 20E) system to increase accuracy and reproducibility of the test for biotype characterization of bacteria

Procedures employing the Analytab Enteric (API 20E) system were standardized to improve the accuracy and reproducibility of the individual biochemical tests so that the system could be used to biochemically characterize bacteria for epidemiological studies. The standardized method and the method recommended by the manufacturer (routine method) were tested in parallel with 130 clinical isolates. Tests with 100 randomly selected clinical isolates demonstrated that the standardized method was more accurate and reproducible than the routine method. In addition, the standardized method accurately identified 24 of 30 clinical isolates which could not be identified with the routine method.

Biotyping of Serratia marcescens and its use in epidemiological studies

A Serratia marcescens biotyping system using eight carbon sources (benzoate, DL-carnitine, m-erythritol, 3-hydroxybenzoate, 4-hydroxybenzoate, lactose, D-quinate, and trigonelline), a tetrathionate reduction test, production of prodigiosin, and horse blood hemolysis was derived from a recent numerical taxonomic study (Grimont et al., J. Gen. Microbiol. 98:39-66, 1977). A total of 98.6% of 2,210 isolates from various sources could be assigned to 1 of 19 biotypes. Distribution and spread of 1,088 S. marcescens isolates throughout 13 clinical departments of Pellegrin Hospital (Bordeaux, France) were studied from 1968 through 1975. Except for one that colonized the intestinal tract of newborns, the six pigmented biotypes were seldom isolated. Each of the 13 nonpigmented biotypes showed a particular pattern of distribution and spread. The usefulness of S. marcescens biotyping was shown by relating several isolates recovered from patients and their inanimate environment and by pointing out the possible existence of infections or colonizations by two unrelated biotypes. S. marcescens strains isolated from the natural environment (water) are usually pigmented, and their biotypes are uncommon in hospitals. Biotyping can, therefore, be of help in epidemiological and ecological surveys.

Relationship of K1 antigen to biotype in clinical isolates of Escherichia coli

Two hundred and ninety-four isolates of Escherichia coli, including 105 from blood cultures, 94 from stools of hospital inpatients, and 96 from rectal cultures of healthy young adults, were biotyped by using the API-20E system and tested for the presence of K1 antigen. The overall frequency of K1 strains was 14.2% and was similar among the three sources. Forty-eight biotypes were observed, but two-thirds of all isolates, including two-thirds of the K1 strains, belonged to only five biotypes. Among the five commonest biotypes, the distribution of K1 strains was nonrandom, since 23 of the 27 K1 strains belonged to only two biotypes. Analysis of the O and H antigens of K1 strains indicated that this correlation of biotype with K1 antigen was due to a restricted number of serovars ("clones") that were repeatedly isolated from the population studied. These serovas included O18:K1:H7, O1:121:H6 and O16:K1:H6. Although a statistically significant correlation between biotype and K1 antigen was observed, the correlation was not sufficiently great to alow biotyping to be of significant predictive value as a marker for the K1 antigen.

Multiple biotypes of Klebsiella pneumoniae in single clinical specimens

The occurence of multiple biotypes of Klebsiella pneumoniae within single specimens was determined in 59 clinical specimens. Biotyping was performed on five colonies of K. pneumoniae from each specimen, using the API 20E system (Analytab, Inc., New York) for identification of Enterobacteriaceae with strict adherence to the manufacturer's instructions. Multiple biotypes of K. pneumoniae were present in 31% (18) of the clinical specimens. Twenty-eight colonies representative of specimens with single and multiple biotypes were tested further for biotype reproducibility. Whereas genus and species identification was 100% reproducible, variation of one or more biochemical tests on serial transfers resulted in biotype reproducibility of only 64%. The greatest variation in biochemical tests occurred with urease (14%), indole production (10%) and citrate utilization (9%). Multiple biotypes in single specimens appear to be due to both inherent differences among the colonies in the specimen and variability in the system used to determine biochemical reactions. The presence of multiple biotypes limits the usefulness of biochemical typing for epidemiological surveilance of K. pneumoniae.