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Multidrug-resistant Shewanella putrefaciens isolated from ascitic fluid in a patient with decompensated cirrhosis: A
Ziheng Wang1, Jiaxu Qin2, Rui Kong3
1Department of Laboratory Medicine, The First Affiliated Hospital of Wannan Medical University, Wuhu, Anhui 241000, China.
Background:
Shewanella putrefaciens is a rare opportunistic pathogen found in marine, freshwater, and soil environments. Although it is increasingly recognized as a cause of human infection, reports of NDM- and OXA-48-like carbapenemase-producing S. putrefaciens isolated from ascitic fluid in patients with decompensated cirrhosis remain exceedingly rare.
Case Presentation:
A 68-year-old man with chronic hepatitis B-related decompensated cirrhosis and diabetes mellitus was readmitted with progressive abdominal distension and oliguria. He had no history of seawater or freshwater exposure or raw seafood consumption. Ascitic fluid analysis showed markedly elevated nucleated cell counts, with calculated polymorphonuclear neutrophil counts consistently exceeding 250 cells/µL, supporting bacterial peritonitis. Ascitic fluid culture yielded S. putrefaciens, which was identified by MALDI-TOF MS with 99.9% confidence. Immunochromatographic testing and PCR confirmed production of NDM and OXA-48-like carbapenemases. The isolate was multidrug resistant, with resistance to most β-lactams, carbapenems, aztreonam, quinolones, and trimethoprim/sulfamethoxazole, but it remained susceptible to amikacin, tobramycin, and minocycline. Treatment was adjusted to colistin methanesulfonate combined with amikacin-based therapy, along with ascitic drainage and supportive care. Abdominal symptoms partially improved, but the patient requested discharge before completing antimicrobial treatment.
Conclusion:
S. putrefaciens can cause clinically significant ascitic fluid infection in patients with decompensated cirrhosis, even without aquatic exposure. Accurate species identification, antimicrobial susceptibility testing, and carbapenemase detection are essential for guiding targeted therapy.
Insights
This study reports a rare case of Shewanella putrefaciens causing infection in a patient with decompensated cirrhosis. The bacteria produced NDM and OXA-48-like carbapenemases, highlighting the need for accurate diagnostics in such infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- Shewanella putrefaciens is an opportunistic pathogen found in various environments.
- Human infections with S. putrefaciens are uncommon, and carbapenemase-producing strains are exceptionally rare.
- This case involves NDM- and OXA-48-like carbapenemase-producing S. putrefaciens in ascitic fluid of a patient with decompensated cirrhosis.
