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Background <p><i>Serratia marcescens (S. marcescens)</i>&#xa0;is a gram-negative opportunistic pathogen causing healthcare-associated infections in neonatal intensive care units (NICUs), with mortality rates of 22.4%–58.0% and multi-drug complicating treatment. Fragmented evidence on risk factors limits infection prevention and control (IPC) strategies.</p> Methods <p>Following PRISMA guidelines, we searched PubMed, Web of Science, Wanfang, and CNKI databases from inception to April 25, 2025 for studies in English or Chinese, examining risk factors for&#xa0;<i>S. marcescens</i>&#xa0;infection or colonization in neonates. All reported risk factors were extracted, with those reported in ≥ 3 studies defined as primary outcomes, and those reported in two studies defined as secondary outcomes. Pooled odds ratios (<i>OR</i>s) with 95% confidence intervals (<i>CI</i>s) were calculated using random- or fixed-effects models based on <i>I</i><sup><i>2</i></sup> heterogeneity. Sensitivity and publication bias analyses were conducted.</p> Results <p>Twelve studies were included. Prematurity (<i>OR</i> = 2.90, 95%<i>CI</i>: 2.12–3.96) and very low birth weight (VLBW) (<i>OR</i> = 2.34, 95%<i>CI</i>: 1.48–3.72) were key host-related risk factors. Invasive procedures, including oral/nasogastric tube (a<i>OR</i> = 5.10, 95% <i>CI</i>: 3.06–8.52), arterial catheterization, surgery, continuous positive airway pressure(CPAP), mechanical ventilation, and central venous catheterization (CVC), significantly increased risk. Antibiotic exposure (a<i>OR</i> = 2.04, 95% <i>CI</i>: 1.06–3.93) was a modifiable risk factor, while breastfeeding (<i>OR</i> = 0.45, 95% <i>CI</i>: 0.27–0.75) and vaginal delivery (a<i>OR</i> = 0.51, 95% <i>CI</i>: 0.34–0.76) were protective.</p> Conclusion <p>This systematic review synthesized evidence on risk factors for <i>S. marcescens</i> in neonates, with outcomes categorized by reporting frequency. Findings advocate for targeted IPC strategies such as antimicrobial stewardship and promotion of protective practices. Limited by case–control designs, future genomic multi-center studies are needed to confirm causality and transmission.</p>

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Risk factors for healthcare-associated infection and colonization of Serratia marcescens in neonates: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月1日

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  • Ya-Qian Hu,
  • Sheng-Fan Xue,
  • Rui-zhe Yang,
  • Yu-Wen Bao,
  • Heng Zhang,
  • Jing Hu,
  • Xu Wang,
  • Yan-Qun Sun

摘要

Background

Serratia marcescens (S. marcescens) is a gram-negative opportunistic pathogen causing healthcare-associated infections in neonatal intensive care units (NICUs), with mortality rates of 22.4%–58.0% and multi-drug complicating treatment. Fragmented evidence on risk factors limits infection prevention and control (IPC) strategies.

Methods

Following PRISMA guidelines, we searched PubMed, Web of Science, Wanfang, and CNKI databases from inception to April 25, 2025 for studies in English or Chinese, examining risk factors for S. marcescens infection or colonization in neonates. All reported risk factors were extracted, with those reported in ≥ 3 studies defined as primary outcomes, and those reported in two studies defined as secondary outcomes. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models based on I2 heterogeneity. Sensitivity and publication bias analyses were conducted.

Results

Twelve studies were included. Prematurity (OR = 2.90, 95%CI: 2.12–3.96) and very low birth weight (VLBW) (OR = 2.34, 95%CI: 1.48–3.72) were key host-related risk factors. Invasive procedures, including oral/nasogastric tube (aOR = 5.10, 95% CI: 3.06–8.52), arterial catheterization, surgery, continuous positive airway pressure(CPAP), mechanical ventilation, and central venous catheterization (CVC), significantly increased risk. Antibiotic exposure (aOR = 2.04, 95% CI: 1.06–3.93) was a modifiable risk factor, while breastfeeding (OR = 0.45, 95% CI: 0.27–0.75) and vaginal delivery (aOR = 0.51, 95% CI: 0.34–0.76) were protective.

Conclusion

This systematic review synthesized evidence on risk factors for S. marcescens in neonates, with outcomes categorized by reporting frequency. Findings advocate for targeted IPC strategies such as antimicrobial stewardship and promotion of protective practices. Limited by case–control designs, future genomic multi-center studies are needed to confirm causality and transmission.