Table 1.
Cases of Shewanella Infection in Naval Special Warfare Trainees
| Case | Age, y | Clinical Syndromes | Site of Shewanella Isolation | Treatments (Listed Consecutively) |
|---|---|---|---|---|
| 1 | 26 | First admission | ||
| Shewanella algae bacteremia; polymicrobial intertriginous groin wound infection (S. algae, Streptococcus agalactiae, Pseudomonas aeruginosa, Enterococcus faecalis, Staphylococcus aureus) | - Blood culture | - Moxifloxacin for 1 d | ||
| - Groin wound culture | - Piperacillin-tazobactam + vancomycin for 6 d | |||
| - Levofloxacin for 8 d | ||||
| Second admission | ||||
| - Left distal thigh abscess | - Shewanella not identified (culture obtained on antibacterial therapy) | - I&D | ||
| - Piperacillin-tazobactam + vancomycin for 5 d | ||||
| - Levofloxacin for 10 d | ||||
| 2 | 21 | - S. algae and P. aeruginosa suppurative otitis media following ruptured right tympanic membrane | - Wound culture from right otic canal | - Failed oral amoxicillin and ciprofloxacin ear drops |
| - Switched to oral ciprofloxacin for 14 d | ||||
| 3 | 21 | - Multiple right lower extremity pretibial abscesses growing S. algae and S. aureus | - Wound culture from abscesses | - I&D with wound VAC |
| - Cefazolin and vancomycin following I&D | ||||
| - Switched to oral clindamycin to finish a 14-d course | ||||
| 4 | 20 | - Groin and bilateral lower extremity SSTI, polymicrobial (S. algae, S. aureus, group G streptococci, Acinetobacter haemolyticus) | - Wound culture from lower extremity wound drainage | - Local wound care |
| - 4 d of vancomycin and ceftriaxone | ||||
| - Switched to oral dicloxacillin for an additional 3 d | ||||
| 5 | 26 | Polymicrobial necrotizing fasciitis of left lower extremity (S. algae, E. faecalis, Vibrio harveyi); V. harveyi bacteremia | - Operative wound cultures from debrided necrotic soft tissue | - Wide excisional debridement with split thickness skin graft of left lower extremity |
| - Linezolid and meropenem for 7 d while in the ICU | ||||
| - Ceftazidime for 14 d | ||||
| 6 | 24 | - S. algae, S. aureus, and E. faecalis polymicrobial bacteremia secondary to extensive SSTI involving the groin and bilateral lower extremities | - Blood culture | - 14 d of IV daptomycin and ceftriaxone |
| - Groin and lower extremity wound cultures |
Abbreviations: I&D, incision and drainage; ICU, intensive care unit; SSTI, skin and soft tissue infection; VAC, vacuum-assisted closure.