17630
2014
AOPXXX10.1177/1060028013517630Annals of PharmacotherapyJacob-Kokura et al
Case Report
Bacteremia and Empyema Caused by Shewanella algae in a Trauma Patient
Annals of Pharmacotherapy 2014, Vol. 48(1) 128–136 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1060028013517630 aop.sagepub.com
Susan Jacob-Kokura, PharmD1, Claire Y. Chan, PharmD, BCPS1, and Lewis Kaplan, MD, FACS, FCCM, FCCP2,3
Abstract 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 deescalation based on culture-derived data. Keywords Shewanella algae, Shewanella alga, Shewanella putrefaciens, Achromobacter putrefaciens, Pseudomonas putrefaciens, bacteremia, pneumonia, empyema, clinical infections
Introduction Injured patients are at risk of infection as a direct result of their injury as well as from the interventions required to control or repair their injury. Such infections are typically categorized on the basis of whether they were related to community pathogens or hospital-acquired pathogens, as interventions designed to prevent their future occurrence may be quite different. Depending on the source of the infection, some patients will not readily fit into the standard antibiotic regimens that are commonly used for community or hospital-acquired pathogens. Relatedly, performance improvement efforts with regard to postintervention infection are well scrutinized and are the focus of national initiatives.1,2 However, a postinjury and intervention infection may be directly related to the injury and not the intervention, and cannot be prevented by postinjury measures. By way of example, we describe the first case of a critically ill
patient with bacteremia and empyema caused by Shewanella algae whose infection was related to his initial injury and not the subsequent interventions, as well as a pertinent literature review.
Methods MEDLINE and PubMed searches were performed using the search terms Shewanella algae, Shewanella alga, Shewanella 1
Yale–New Haven Hospital, New Haven, CT, USA Yale University School of Medicine, New Haven, CT, USA 3 Yale Trauma, Surgical Critical Care and Surgical Emergencies, New Haven, CT, USA 2
Corresponding Author: Claire Chan, PharmD, BCPS, Department of Pharmacy Services, Yale– New Haven Hospital, 20 York Street, New Haven, CT 06510, USA. Email: [email protected]
129
Jacob-Kokura et al Table 1. Shewanella algae Susceptibilities.
Agent Ceftazidime Levofloxacin Meropenem Minocycline Ticarcillin/clavulanic acid Trimethoprim/ sulfamethoxazole
Shewanella algae Susceptibility MIC (µg/ mL) Breakpointsa
Blood Culture Strain 1 MIC (µg/mL) PID 8
Blood Culture Strain 2 MIC (µg/mL) PID 8
Pleural Fluid Strain 1 MIC (µg/mL) PID 21
Pleural Fluid Strain 2 MIC (µg/mL) PID 21
2014
AOPXXX10.1177/1060028013517630Annals of PharmacotherapyJacob-Kokura et al
Case Report
Bacteremia and Empyema Caused by Shewanella algae in a Trauma Patient
Annals of Pharmacotherapy 2014, Vol. 48(1) 128–136 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1060028013517630 aop.sagepub.com
Susan Jacob-Kokura, PharmD1, Claire Y. Chan, PharmD, BCPS1, and Lewis Kaplan, MD, FACS, FCCM, FCCP2,3
Abstract 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 deescalation based on culture-derived data. Keywords Shewanella algae, Shewanella alga, Shewanella putrefaciens, Achromobacter putrefaciens, Pseudomonas putrefaciens, bacteremia, pneumonia, empyema, clinical infections
Introduction Injured patients are at risk of infection as a direct result of their injury as well as from the interventions required to control or repair their injury. Such infections are typically categorized on the basis of whether they were related to community pathogens or hospital-acquired pathogens, as interventions designed to prevent their future occurrence may be quite different. Depending on the source of the infection, some patients will not readily fit into the standard antibiotic regimens that are commonly used for community or hospital-acquired pathogens. Relatedly, performance improvement efforts with regard to postintervention infection are well scrutinized and are the focus of national initiatives.1,2 However, a postinjury and intervention infection may be directly related to the injury and not the intervention, and cannot be prevented by postinjury measures. By way of example, we describe the first case of a critically ill
patient with bacteremia and empyema caused by Shewanella algae whose infection was related to his initial injury and not the subsequent interventions, as well as a pertinent literature review.
Methods MEDLINE and PubMed searches were performed using the search terms Shewanella algae, Shewanella alga, Shewanella 1
Yale–New Haven Hospital, New Haven, CT, USA Yale University School of Medicine, New Haven, CT, USA 3 Yale Trauma, Surgical Critical Care and Surgical Emergencies, New Haven, CT, USA 2
Corresponding Author: Claire Chan, PharmD, BCPS, Department of Pharmacy Services, Yale– New Haven Hospital, 20 York Street, New Haven, CT 06510, USA. Email: [email protected]
129
Jacob-Kokura et al Table 1. Shewanella algae Susceptibilities.
Agent Ceftazidime Levofloxacin Meropenem Minocycline Ticarcillin/clavulanic acid Trimethoprim/ sulfamethoxazole
Shewanella algae Susceptibility MIC (µg/ mL) Breakpointsa
Blood Culture Strain 1 MIC (µg/mL) PID 8
Blood Culture Strain 2 MIC (µg/mL) PID 8
Pleural Fluid Strain 1 MIC (µg/mL) PID 21
Pleural Fluid Strain 2 MIC (µg/mL) PID 21
