Peritonitis caused by Pseudomonas putrefaciens in patients undergoing continuous ambulatory peritoneal dialysis

Emerging Infections Due to Shewanella spp.: A Case Series of 128 Cases Over 10 Years

Background

Shewanella species are emerging pathogens that can cause severe hepatobiliary, skin and soft tissue, gastrointestinal, respiratory infections, and bacteremia. Here we reported the largest case series of infections caused by Shewanella species.

Aim

To identify the clinical features and risk factors predisposing to Shewanella infections. To evaluate resistance pattern of Shewanella species and appropriateness of antibiotic use in the study cohort.

Methods

Patients admitted to a regional hospital in Hong Kong with Shewanella species infection from April 1, 2010 to December 31, 2020 were included. Demographics, antibiotics, microbiology, and outcomes were retrospectively analyzed.

Findings

Over the 10 years, we identified 128 patients with Shewanella species infection. 61.7% were male with a median age of 78 (IQR 65–87). Important underlying diseases included hepatobiliary diseases (63.3%), malignancy (26.6%), chronic kidney disease or end-stage renal failure (25.8%), and diabetes mellitus (22.7%). Hepatobiliary infections (60.4%) were the most common clinical manifestation. Majority (92.2%) were infected with Shewanella algae, while 7.8% were infected with Shewanella putrefaciens. The identified organisms were usually susceptible to ceftazidime (98.7%), gentamicin (97.4%), cefoperazone-sulbactam (93.5%) and ciprofloxacin (90.3%). Imipenem-susceptible strains were only present in 76.6% of isolates.

Conclusion

This largest case series suggested that Shewanella infections are commonly associated with underlying comorbidities, especially with hepatobiliary diseases and malignancy. Although Shewanella species remained largely susceptible to third and fourth generation cephalosporins and aminoglycosides, carbapenem resistance has been on a significant rise.

Shewanella algae Peritonitis in Patients on Peritoneal Dialysis

Patients with peritonitis present with abdominal pain, diarrhea, fever, and turbid peritoneal dialysis (PD) fluid. Shewanella algae peritonitis has not yet been reported in PD patients in the literature. We present the first 2 cases of Shewanella algae peritonitis in PD patients. Mupirocin cream is applied on the exit site as prophylactic antibiotic therapy.

Quantitative and qualitative analyses of the bacterial microbiota of tilapia (Oreochromis niloticus) cultured in earthen ponds in the Philippines

The quantity and composition of the bacterial microbiota in the rearing water, sediment, gills and intestines of tilapia Oreochromis niloticus collected every 2 weeks from Day 30 to Day 120 after stocking for grow-out culture in 6 earthen brackish water ponds in the Philippines were examined. The total heterotrophic aerobic bacterial counts obtained in the water, sediment, gills and intestines of tilapia ranged from 10(3) to 10(4) c.f.u. ml(-1), 10(3)-10(5), 10(5)-10(7) and 10(4)-10(7) c.f.u. g(-1), respectively. In terms of composition, a total of 20 bacterial genera and 31 species were identified with the preponderance of gram-negative bacteria constituting 84 % of all bacterial isolates examined. Aeromonas hydrophila, Bacillus spp., Plesiomonas shigelloides, Shewanella putrefaciens, Pseudomonas fluorescens, Staphylococcus spp. and Vibrio cholerae were the dominant bacteria identified in the gills and intestine of tilapia. These bacteria also dominated in the pond sediment and rearing water, except for the nil isolation of S. putrefaciens and V. cholerae in the water samples examined, indicating that resident bacteria in the pond water and sediment congruently typify the composition of bacterial microbiota in the gills and intestine of tilapia which under stressful conditions may propel the ascendance of disease epizootics.

Bacteremia and empyema caused by Shewanella algae in a trauma patient

OBJECTIVE

To describe the first reported case of bacteremia and empyema caused by Shewanella algae and summarize the existing literature on Shewanella human infection.

CASE SUMMARY

A 25-year-old healthy male was shot through the chest into the abdomen and fled into an adjacent body of seawater. He underwent surgical repair of his injuries, including pleural decortication. Leukocytosis, bandemia, and copious yellow bronchorrhea led to cultures; piperacillin/tazobactam and vancomycin were started for broad-spectrum empiric management based on the local intensive care unit antibiogram. Blood and pleural fluid cultures revealed S algae. Sputum cultures grew methicillin-sensitive Staphylococcus aureus and Haemophilus influenzae. He was successfully managed with an empiric and then tailored antibiotic regimen.

DISCUSSION

Shewanella algae is a rare Gram-negative bacillus that has infrequently been reported to cause infection. It is found predominantly in men. Shewanella algae infections span bacteremia to necrotizing soft tissue infection and are associated with injury and seawater exposure. Shewanella is susceptible to the majority of third- and fourth-generation cephalosporins, aminoglycosides, chloramphenicol, erythromycin, aztreonam, and fluoroquinolones, but are less predictably susceptible to tetracycline and trimethoprim/sulfamethoxazole and carbapenem agents. Shewanella infection is associated with medical comorbidities, in particular, renal failure and cardiovascular disease.

CONCLUSIONS

To our knowledge, this is the first case report of bacteremia and empyema caused by S algae. Such a case involving a young healthy individual should encourage health care providers to be aware of the potential infections caused by unusual pathogens, and to employ appropriate empiric antibiotic therapy based on reported sensitivity profiles. Based on available susceptibilities, we recommend using a third or fourth-generation cephalosporin as first-line pharmacologic management with regimen de-escalation based on culture-derived data.

Human infection with Shewanella putrefaciens and S. algae: report of 16 cases in Martinique and review of the literature

Shewanella spp. are saprophytic bacteria that are part of the marine microflora in warm climates and are rarely pathogenic. However, Shewanella spp. infections are being increasingly reported, and there has been no comprehensive review of the literature describing these infections. This article reports 16 cases of Shewanella spp. infections in Martinique since 1997 and reviews another 239 cases reported in the literature since 1973. Patients experienced soft tissue infections, ear infection, or abdominal and biliary tract infections. A skin or mucosal portal of entry was found for 53% of the patients and exposure to the marine environment was reported for 44%; 79% of patients had an underlying condition. Bacteriema were frequent (28%). Most (87%) patients recovered, although ear infections can become chronic. Death occurred in 13% of the patients. Most Shewanella spp. isolates are susceptible to cefotaxime (95%), piperacillin and tazobactam (98%), gentamicin (99%), and ciprofloxacin (94%).

Outbreak of Shewanella algae and Shewanella putrefaciens infections caused by a shared measuring cup in a general surgery unit in Korea

OBJECTIVE

To control an outbreak of Shewanella algae and S. putrefaciens infections by identifying the risk factors for infection and transmission.

DESIGN

Matched case-control study.

SETTING

A university-affiliated tertiary acute care hospital in Seoul, Republic of Korea, with approximately 1,600 beds.

PATIENTS

From June 20, 2003, to January 16, 2004, a total of 31 case patients with Shewanella colonization or infection and 62 control patients were enrolled in the study.

INTERVENTIONS

Requirement to use single-use measuring cups and standard precautions (including hand washing before and after patient care and use of gloves).

RESULTS

S. algae or S. putrefaciens was isolated from blood, for 9 (29.0%) of 31 patients who acquired one of the organisms; from bile, for 8 (25.8%), and from ascitic fluid, for 8 (25.8%). The attack rate of this outbreak was 5.8% (31 patients infected or colonized, of 534 potentially exposed on ward A) and the pathogenicity of the two species together was 77.4% (24 patients infected, of 31 who acquired the pathogens). The estimated incubation period for Shewanella acquisition was 3-49 days. Using logistic analysis, we identified the following risk factors: presence of external drainage catheters in the hepatobiliary system (odds ratio [OR], 20; P < .001), presence of hepatobiliary disease (OR, 6.4; P < .001), admission to the emergency department of the hospital (OR, 2.9; P = .039), wound classification of "contaminated" or "dirty or infected" (OR, 16.5; P = .012), an American Society of Anesthesiologists score of 3 or higher (OR, 8.0; P = .006), duration of stay in ward A (OR, 1.1; P < .001), and, for women, an age of 60-69 years (OR, 13.3; P = .028). A Shewanella isolate was recovered from the surface of a shared measuring cup, and 12 isolates of S. algae showed the same pulsed-field gel electrophoresis pattern.

CONCLUSIONS

This Shewanella outbreak had a single-source origin and spread by contact transmission via a contaminated measuring cup. Shewanella species are emerging as potentially serious human pathogens in hospitals and could be included in hospital infection surveillance systems.

[Opportunistic infections caused by Shewanella, new emergent bacteria]

Shewanella putrefaciens and Shewanella algae are Gram negative, nonfermentative and oxidative bacilli whose the main phenotypic feature is the production of hydrogen sulfide gas. Widespread in the environment, both S. putrefaciens and S. algae species are rare human bacteria although they are reported with increasing frequency as a cause of opportunistic infection in humans, such as skin and soft tissue infections and bacteremia. Chronic infections of the lower limbs and liver disease have been identified as risk factors for bloodstream infection, with a faster course and a poorer prognosis in the last case. S. algae appears to be more virulent than S. putrefaciens. Most human S. putrefaciens strains are isolated from bacterial flora, which puts to question its clinical significance. Molecular biology must be used for an adequate identification because S. algae can easily be mistaken for S. putrefaciens with usual tests.

[Infection peritonitis in patients undergoing continuous ambulatory peritoneal dialysis: microbiological review during an four-year period]

The purpose of this study was to analyse the microbiological characteristics of infectious peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. This study was conducted at the CHU Nancy from 1999 to 2002. The diagnosis of peritonitis was based on cloudy peritoneal effluent (>100 cells per mm(3)) with an elevated leukocyte count (>50%), on isolation of bacteria or fungi and on symptoms such as abdominal discomfort or pain. The majority of infections associated with continuous ambulatory peritoneal dialysis were caused by Gram-positive bacteria (68%), Gram-negative bacteria (31%), and Candida (1%). The coagulase-negative staphylococci were the most common cause of peritonitis. The antibiotic sensitivity of species corresponded to community-acquired isolation.

Structure of a phosphorylated polysaccharide from Shewanella putrefaciens strain S29

A phosphorylated polysaccharide was isolated from the aqueous layer of the phenol-water extract of a non-halophilic bacterium Shewanella putrefaciens strain S29. The glycosyl phosphate linkage in the polysaccharide was split under mild acid conditions to give, after borohydride reduction, a phosphorylated oligosaccharide-alditol. On the basis of sugar analysis and 1H, 13C and 31P NMR spectroscopy, including 2D COSY, relayed COSY, rotating-frame NOE spectroscopy (ROESY), heteronuclear 13C,1H COSY, and H-detected heteronuclear 1H,31P multiple-quantum coherence (HMQC), it was concluded that the polysaccharide is built up of tetrasaccharide-phosphate repeating units having the following structure: [sequence: see text] where QuiNAc and Qui4NAc are 2-acetamido-2,6-dideoxyglucose and 4-acetamido-4,6-dideoxyglucose, respectively.

Differentiation of Shewanella putrefaciens and Shewanella alga on the basis of whole-cell protein profiles, ribotyping, phenotypic characterization, and 16S rRNA gene sequence analysis

Seventy-six presumed Shewanella putrefaciens isolates from fish, oil drillings, and clinical specimens, the type strain of Shewanella putrefaciens (ATCC 8071), the type strain of Shewanella alga (IAM 14159), and the type strain of Shewanella hanedai (ATCC 33224) were compared by several typing methods. Numerical analysis of sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole-cell protein and ribotyping patterns showed that the strains were separated into two distinct clusters with 56% +/- 10% and 40% +/- 14% similarity for whole-cell protein profiling and ribotyping, respectively. One cluster consisted of 26 isolates with 52 to 55 mol% G + C and included 15 human isolates, mostly clinical specimens, 8 isolates from marine waters, and the type strain of S. alga. This homogeneous cluster of mesophilic, halotolerant strains was by all analyses identical to the recently defined species S. alga (U. Simidu et al., Int. J. Syst. Bacteriol, 40:331-336, 1990). Fifty-two typically psychrotolerant strains formed the other, more heterogeneous major cluster, with 43 to 47 mol% G + C. The type strain of S. putrefaciens was included in this group. The two groups were confirmed by 16S rRNA gene sequence analysis. It is concluded that the isolates must be considered two different species, S. alga and S. putrefaciens, and that most mesophilic isolates formerly identified as S. putrefaciens belong to S. alga. The ecological role and potential pathogenicity of S. alga can be evaluated only if the organism is correctly identified.