A Rare Cause of Empyema and Bacteremia Due to Shewanella Species in Alcoholic Cirrhosis Patients: A Case Report and Comprehensive Review of Literature

Bohui Qian; Kazuhiro Ishikawa; Tomoaki Nakamura; Katsuhito Kinoshita; Tetsuhiro Masaki; Takahiro Matsuo; Fujimi Kawai; Nobuyoshi Mori

doi:10.12659/AJCR.941952

10 April 2024 : Case report Japan

A Rare Cause of Empyema and Bacteremia Due to Shewanella Species in Alcoholic Cirrhosis Patients: A Case Report and Comprehensive Review of Literature

Unusual clinical course

Bohui Qian^1BCDEF, Kazuhiro Ishikawa^1ABDEF*, Tomoaki Nakamura^2CDEF, Katsuhito Kinoshita^2CDEF, Tetsuhiro Masaki^1CF, Takahiro Matsuo^1ADE, Fujimi Kawai

^3ABF, Nobuyoshi Mori

^1DE

DOI: 10.12659/AJCR.941952

Am J Case Rep 2024; 25:e941952

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Introduction Case Report Discussion Conclusions References:

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Table 3. Baseline characteristics, management/treatment, and prognosis of patients with Shewanella spp. bacteremia.

Case No	Case reference published year	Published country	Age, sex	Underlying disease	Chief complaint	Type of infection	Specimen
1	Kazami Y, 2020 []⁸	Japan	66 y, M	Esophagus cancer	SSI, septic shock	SSTI, bacteremia	Blood, drainage, surgical site
2	Kitaoka M, 2019 []⁹	Japan	60 y, M	HCC	Fever	Cholangitis, bacteremia	Blood, bile
3	Kitaoka M, 2019 []⁹	Japan	76 y, M	Cholangiocarcinoma	Fever, septic shock	Cholangitis, bacteremia	Blood
4	Kitaoka M, 2019 []⁹	Japan	76 y, M	Cholangiocarcinoma	Fever	Cholangitis, bacteremia	Blood
5	Kimura H, 2018 []¹⁰	Japan	66 y, M	CKD on HD, cirrhosis, DM, colon cancer	Fever, redness of hand	SSTI, bacteremia	Blood
6	Takata T, 2017 []¹¹	Japan	71 y, M	CKD	Nausea, abdominal pain	IE, bacteremia	Blood
7	Roger SD, 1991 []¹²	Australia	62 y, M	CKD on PD	Productive cough, acute arthritis of wrist and ankle, right upper quadrant abdominal pain	Oligoarthritis, bacteremia	Blood, sputum
8	Iwata M, 1999 []¹³	Japan	64 y, F	CKD on HD	Fever, general fatigue	bacteremia	Blood
9	Bhandari S, 2000 []¹⁴	Australia	69 y, M	CKD on PD, CABG, DM	Fever, chills, upper abdominal pain, dyspnea, general fatigue	Splenic abscess, bacteremia	Blood, peritoneal fluid, splenic abscess
10	Jammula P, 2003 []¹⁵	USA	58 y, M	CKD on HD	Pain of arm, nausea, vomiting, abdominal discomfort	Myonecrosis, bacteremia	Blood, aspirate of bulbous lesions and tissue culture
11	Yim SY, 2010 []¹⁶	Korea	67 y, M	CKD on PD, chronic glomerulonephritis, CAPD peritonitis	Fever, abdominal pain	Necrotizing fasciitis, peritonitis, bacteremia	Blood, peritoneal fluid
12	Shrishrimal K, 2012 []¹⁷	USA	78 y, M	DM, peripheral vascular disease, CKD on HD (tunneled HD catheter), brachiobasilic arteriovenous fistula	Fever	Bacteremia	Blood, tip of catheter
13	Lee WS, 2016 []¹⁸	Taiwan	82 y, F	CKD on HD, cervical cancer, hydronephrosis	Fever, chills	Bacteremia	Blood
14	Kinjo M, 2017 []¹⁹	Japan	83 y, M	COPD	Dyspnea, chest pain	Empyema, bacteremia	Blood, pleural effusion
15	Kanameishi S, 2016 []²⁰	Japan	70 y, M	Stasis dermatitis, MI	Redness and swelling of leg	SSTI, bacteremia	Blood
16	Uemura M, 2013 []²¹	Japan	75 y, M	Cholangiocarcinoma	Fever	Cholangitis, bacteremia	Blood
17	Liu P-Y, 2013 []²²	Taiwan	80 y, M	Ampullary carcinoma	NA	Cholangitis	Blood
18	Liu P-Y, 2013 []²²	Taiwan	91 y, M	Cholangiocarcinoma	NA	Cholangitis	Blood
19	Liu P-Y, 2013 []²²	Taiwan	77 y, M	CBD stone, HBV	NA	Cholangitis	Blood
20	Liu P-Y, 2013 []²²	Taiwan	66 y, M	Hepatoma, LC, HBV	NA	Infected biloma	Blood
21	Liu P-Y 2013 []²²	Taiwan	81 y, M	Hepatoma	NA	Liver abscess	Blood
22	Liu P-Y, 2013 []²²	Taiwan	55 y, M	LC, HBV	NA	Cellulitis	Blood
23	Liu P-Y, 2013 []²²	Taiwan	71 y, F	Lung cancer	NA	Bacteremia	Blood
24	Liu P-Y, 2013 []²²	Taiwan	68 y, M	Gall bladder stone	NA	Cholecystitis	Blood
25	Liu P-Y 2013 []²²	Taiwan	47 y, M	Hepatoma, LC, HCV, DM	NA	Bacteremia	Blood
26	Fukunaga M, 2013 []²³	Japan	84 y, M	DM, gastric cancer, cecal cancer, choledocholithiasis	Fever, epigastric pain, loss of appetite	Cholecystitis, bacteremia	Blood, bile
27	Fukunaga M, 2013 []²³	Japan	74 y, F	DM, autoimmune pancreatitis	Fever	Bacteremia	Blood
28	Munetsugu T, 2012 []²⁴	Japan	76 y, F	Pancreatic cancer	Pain and swelling of leg	SSTI, bacteremia	Skin, blood
29	Tadera K, 2010 []²⁵	Japan	82 y, M	CHF	Pain of leg	SSTI, bacteremia	Abscess, blood
30	Shimizu T, 2009 []²⁶	Japan	89 y, M	IE, CKD, AMI, MR, HT, bladder cancer	Fever, backache, anorexia	Vertebral osteomyelitis	Blood
31	Otsuka T, 2007 []²⁷	Japan	67 y, M	distal gastrectomy, primary sclerosing cholangitis, LC	Fever, general fatigue, pain and rash of leg	SSTI, bacteremia	Blood
32	Bernshteyn M, 2020 []²⁸	USA	58 y, M	Atopic dermatitis, psoriasis on risankizumab, HT	Swelling of leg	SSTI, osteomyelitis, bacteremia	Blood, wound
33	Hussain A, 2020 []²⁹	UK	75 y, M	DM, extensive psoriasis, CKD, diabetic foot ulcer	Swelling of leg	SSTI, bacteremia	Blood
34	Bridwell RE, 2019 []³⁰	NA	24 y, M	NA	Swelling of leg and genitals	SSTI, bacteremia	Blood
35	Talbot Z, 2019 []³¹	USA	69 y, M	DM, peripheral arterial disease, HT, HL, obesity, CKD	Recurrent syncopal episodes	SSTI	Blood, wound
36	Bauer MJ, 2019 []³²	USA	26 y, M	None	Watery diarrhea, abdominal pain, nonproductive cough, myalgias, swelling and pain of leg	Bacteremia, SSTI	Blood, wound
37	Bauer MJ, 2019 []³²	USA	24 y, M	None	NA	Bacteremia, SSTI	Blood, wound
38	Latif A, 2019 []³³	USA	70 y, M	CAD, alcoholic cirrhosis, TIPS	Shortness of breath	SSTI, bacteremia, CHF	Blood
39	Brugnaro P, 2019 []³⁴	Italy	74 y, M	Chronic phlebitis, recurrent cellulitis	Swelling and pain of leg, fever	SSTI, bacteremia	Blood, wound
40	Raja M, 2018 []³⁵	USA	51 y, M	NA	Pain, swelling, redness and a blister formation over leg	SSTI, bacteremia	Blood, wound
41	Ullah S, 2018 []³⁶	USA	84 y, M	Bleeding peptic ulcer disease, CKD, COPD, stroke, prostate cancer, Paget’s disease	Fever, productive cough, generalized fatigue	Pneumoniae, bacteremia	Blood, sputum
42	Martín- -Rodríguez AJ, 2019 []³⁷	USA	68 y, M	HT, DM, dyslipidemia, CAD	Fever	Bacteremia	Blood
43	Martín- -Rodríguez AJ, 2019 []³⁷	USA	56 y, F	HT, ischemic cardiomyopathy, DM, CAD	fever	bacteremia	blood
44	Martín- -Rodríguez AJ, 2019 []³⁷	USA	32 y, F	Severe asthma, hiatal hernia, GERD, obesity, hyperchole-sterolemia	Fever	Bacteremia	Blood
45	Martín- -Rodríguez AJ, 2019 []³⁷	USA	64 y, M	Lung cancer, DM, asthma	Pericardial effusion and pericarditis	Bacteremia, pericarditis	Blood
46	Martín- -Rodríguez AJ, 2019 []³⁷	USA	80 y, F	Colon and cervix carcinoma, cholecystectomy, pancreatic mass of unknown origin	Nausea, vomiting, fever, abdominal pain	Bacteremia	Blood
47	Martín- -Rodríguez AJ, 2019 []³⁷	USA	67 y, F	DM, CKD, HT, CAD	Sepsis	Bacteremia	Blood
48	Martín- -Rodríguez AJ, 2019 []³⁷	USA	74 y, M	HT, colon carcer, liver and lung metastases, cholecystectomy	High fever, vomiting, diarrhea, unconsciousness, dehydration	Bacteremia	Blood
49	Martín- -Rodríguez AJ, 2019 []³⁷	USA	70 y, M	HT, AF, CAD	Fever	Bacteremia	Blood
50	Ranjan R, 2017 []³⁸	India	24 y, M	Head injury	NA	Bacteremia	Blood
51	Davidson NL, 2017 []³⁹	Australia	69 y, M	Cellulitis, CAD, MVR, AVR, pacemaker, prostate cancer, splenectomy	Fever, nausea, presyncope	Bacteremia, SSTI, septic arthritis	Blood
52	Giroux PA, 2017 []⁴⁰	France	67 y, M	DM	Fever, swollen erythematous of gluteal region	SSTI, bacteremia	Blood
53	Brulliard C, 2017 []⁴¹	France	83 y, F	None	Nausea, vomiting, dehydration, loss of consciousness	SSTI, bacteremia	Blood
54	Tang TH, 2016 []⁴²	China	65 y, M	HT, DM, HL, nephrotic syndrome, CKD, CHF	Fever, chill, dyspnea, orthopnea, swelling of ankles	Scrotal abscess, Fournier’s gangrene	Blood, scrotal fluid, scrotal tissue
55	Rajchgot J, 2016 []⁴³	Canada	65 y, M	DM, foot ulceration, HT, CKD	Fever, chill	SSTI, bacteremia	Blood
56	Kim BK, 2014 []⁴⁴	Korea	57 y, M	LC, DM	Hematemesis	Bacteremia, SBP	Blood, ascites
57	Constant J, 2014 []⁴⁵	USA	40 y, M	Seizure disorder, HL, asthma, bronchitis, sleep apnea, HT, hypothyroidism, osteoarthritis, DM	Swelling, calor, numbness, and pain of hand	IE	Blood
58	Jacob-Kokura S, 2014 []⁷	USA	25 y, M	None	Being shot through the chest with a bullet	Empyema, bacteremia	Blood, pleural fluid
59	Ananth AL, 2014 []⁴⁶	USA	72 y, M	HT, AF, chronic venous stasis, ulcer of leg, morbid obesity	Pain, redness and swelling of leg, fever, palpitation	SSTI, bacteremia	Blood
60	Yiallouros P, 2013 []⁴⁷	Cyprus	4 y, M	None	Diarrhea, shivering, stomachache	Ileitis, bacteremia	Blood
61	García-Fragoso L, 2012 []⁴⁸	Puerto Rico	0 y, M	Low birth weight infant, hyaline membrane disease	NA	Bacteremia	Blood
62	Myung DS, 2009 []⁴⁹	Korea	58 y, M	LC	Swelling and pain of foot	Bacteremia, SSTI	Blood, bulla aspirate, tissue
63	Tsai MS, 2008 []⁵⁰	Taiwan	42 y, M	HBV, LC	Fever, swelling of leg	Bacteremia, SSTI	Blood, tissue
64	Vandepitte J, 1978 []⁵¹	Belgium	73 y, F	Anemia, CKD	Fever, leg ulcers	Bacteremia, SSTI	Blood, wound
65	Schmidt U, 1979 []⁵²	USA	63 y, M	Leg ulcers, CHF, LC, gouty arthritis	Fever, leg ulcers	Bacteremia, SSTI	Blood, wound
66	Eschete ML, 1980 []⁵³	USA	67 y, NA	Hypothyroidism, HT, stasis ulcers of legs	Loss of consciousness	Bacteremia, SSTI	Blood
67	Kim JH, 1989 []⁵⁴	USA	34 y, NA	Laurence-Moon-Bardet-Biedl syndrome, CKD, retinal pigmentation, blindness, hypogonadism, obesity	Malaise, fever, chills	Bacteremia, SSTI	Blood
68	Kim JH, 1989 []⁵⁴	USA	39 y, NA	IE, prosthetic aortic valve, chronic leg edema	Fever, chills, nausea, swelling of leg	Bacteremia, SSTI	Blood
69	Kim JH, 1989 []⁵⁴	USA	50 y, NA	Pancreatic carcinoma	AKI, obtundation	Bacteremia, SSTI	Blood
70	Kim JH, 1989 []⁵⁴	USA	78 y, NA	Adenocarcinoma, chronic lung disease	Cough, dyspnea, chest pain	Bacteremia, pneumonia	Blood
71	von Graevenitz A, 1979 []⁵⁵	NA	60 y, NA	Toe gangrene, DM, hypothyroidism	Fever	SSTI, bacteremia	Blood
72	von Graevenitz A, 1979 []⁵⁵	NA	90 y, NA	Orchiectomy, prostate cancer	Mental confusion	Empyema, aspiration pneumonia	Blood, pleural effusion
73	Shimada K, 1981 []⁵⁶	NA	80 y, NA	NA	NA	Cholangitis	Blood
74	Heller HM, 1990 []⁵⁷	USA	75 y, NA	CAD, leg edema secondary to saphenous vein harvest	Fever, chills, redness of leg	Bacteremia, SSTI	Blood
75	Brink AJ, 1995 []⁵⁸	USA	75 y, NA	DM, leg ulcer	NA	Bacteremia, SSTI	Blood
76	Brink AJ, 1995 []⁵⁸	USA	57 y, NA	Leg ulcer, tetanus	NA	Bacteremia, SSTI	Blood
77	Brink AJ, 1995 []⁵⁸	USA	36 y, NA	Leg ulcer, cellulitis	NA	Bacteremia, SSTI	Blood
78	Domínguez H, 1996 []⁵⁹	USA	80 y, NA	RA, DM, arterial insufficiency of the legs, leg ulcers	Edema, erythema, tenderness of leg	Bacteremia, SSTI	Blood
79	Domínguez H, 1996 []⁵⁹	USA	69 y, NA	CHF, leg ulcer	Dyspnea, swelling of leg	Bacteremia, SSTI	Blood
80	Chen YS, 1997 []⁶⁰	China	73 y, NA	Alcoholism, fatty liver	NA	Bacteremia, SSTI	Blood, wound
81	Krsnik I, 2002 []⁶¹	Spain	66 y, NA	Multiple myeloma, CKD	Fever, neutropenia	Bacteremia, SSTI	Blood
82	Pagani L, 2003 []⁶²	Italy	87 y, NA	Cushingoid appearance	Fever, chills, shivering, pain of arm	Bacteremia, SSTI	Blood
83	Saidel-Odes L, 2007 []⁶³	Israel	62 y, NA	Pancreatic tumor with lung and liver metastases, colon cancer, Krukenberg tumor	Hematemesis	Bacteremia	Blood
84	Kim DM, 2006 []⁶⁴	Korea	65 y, NA	Intraductal papillary mucinous tumor	Fever, chills	Bacteremia, peritonitis, epidural abscess	Blood, drainage, epidural abscess
85	Wang IK, 2004 []⁶⁵	Taiwan	61 y, NA	Cholecystectomy	Abdominal pain, fever, chills, nausea, diarrhea	Bacteremia	Blood
86	Paccalin M, 2001 []⁶⁶	France	71 y, NA	Appendicular peritonitis, leg ulcer, HT	Fever, stomachache	Primary infectious aneurysm	Blood, surgical specimens
87	Chen YS, 1997 []⁶⁰	China	51 y, NA	Biliary tract lithiasis, HBV	NA	Bacteremia	Blood
88	Chen YS, 1997 []⁶⁰	China	71 y, NA	biliary tract lithiasis	NA	Bacteremia	Blood
89	Chen YS, 1997 []⁶⁰	China	61 y, NA	LC	NA	Bacteremia	Blood
90	Chen YS, 1997 []⁶⁰	China	71 y, NA	Cholangiocarcinoma with liver invasion	NA	Bacteremia	Blood
91	Chen YS 1997 []⁶⁰	China	85 y, NA	Pancreatic cancer with liver metastasis	NA	Bacteremia	Blood
92	Chen YS, 1997 []⁶⁰	China	81 y, NA	Biliary tract lithiasis	NA	Biliary tract infection	Blood, bile
93	Idowu A, 2020 []⁶⁷		65 y, NA	AIDS, multiple serositis, ascites, chronic bilateral pleural effusion and recurrent pericardial effusion, LC, penile intraepithelial neoplasia, HCV	Fever, productive cough, general fatigue	Bacteremia	Blood
94	Solhjoo M, 2019 []⁶⁸	USA	65 y, NA	NA	NA	NA	NA
95	Blazo J, 2012 []⁶⁹	USA	75 y, NA	CAD, CHF, DM, CKD, anemia	Leg pain	Bacteremia, septic arthritis	Blood, knee aspirate
96	Gandiga PC, 2011 []⁷⁰	USA	53 y, NA	Chronic lymphedema	Malaise, fever	Bacteremia, SSTI	Blood
97	Brink AJ, 1995 []⁵⁸	South Africa	1 d, NA	PDA	NA	Respiratory distress	Blood
98	Brink AJ, 1995 []⁵⁸	South Africa	1 d, NA	Asphyxia neonatorum	NA	Respiratory distress	Blood
99	Brink AJ, 1995 []⁵⁸	South Africa	1 d, NA	Pneumonia	NA	Respiratory distress	Blood
100	Brink AJ, 1995 []⁵⁸	South Africa	1 d, NA	Bochdalek hernia	NA	Respiratory distress	Blood
101	Brink AJ, 1995 []⁵⁸	South Africa	1 d, NA	Meconium aspiration	NA	Respiratory distress	Blood
102	Brink AJ, 1995 []⁵⁸	South Africa	1 d, NA	Meconium aspiration	NA	Respiratory distress	Blood
103	Brink AJ, 1995 []⁵⁸	South Africa	1 d, NA	Pneumonia	NA	Respiratory distress	Blood
104	Brink AJ, 1995 []⁵⁸	South Africa	1 d, NA	Pneumonia	NA	Respiratory distress	Blood
105	Brink AJ, 1995 []⁵⁸	South Africa	Premature, NA	Congenital syphilis	NA	Respiratory distress	Blood
106	Brink AJ, 1995 []⁵⁸	South Africa	l, NA	Pneumonia	NA	Respiratory distress	Blood
107	Brink AJ, 1995 []⁵⁸	South Africa	Premature, NA	Congenital syphilis	NA	Respiratory distress	Blood
108	Brink AJ, 1995 []⁵⁸	South Africa	Premature, NA	NA	NA	Respiratory distress	Blood
109	Brink AJ, 1995 []⁵⁸	South Africa	Premature, NA	NA	NA	Respiratory distress	Blood
110	Brink AJ, 1995 []⁵⁸	South Africa	Premature, NA	Hydrocephalus	NA	Respiratory distress	Blood
111	Brink AJ, 1995 []⁵⁸	South Africa	Premature, NA	NA	NA	Respiratory distress	Blood
112	Brink AJ, 1995 []⁵⁸	South Africa	Premature, NA	Congenital laryngeal cyst	NA	Respiratory distress	Blood
113	Brink AJ, 1995 []⁵⁸	South Africa	6 m, NA	NA	NA	Recurrent bronchopneumonia	Blood
114	Brink AJ, 1995 []⁵⁸	South Africa	12 m, NA	NA	NA	Bronchopneumonia	Blood
115	Brink AJ, 1995 []⁵⁸	South Africa	12 m, NA	NA	NA	Bronchopneumonia	Blood
116	Brink AJ, 1995 []⁵⁸	South Africa	16 y, NA	Burn	NA	Bacteremia	Blood
117	Brink AJ, 1995 []⁵⁸	South Africa	18 y, NA	Burn	NA	Bacteremia	Blood
118	Brink AJ, 1995 []⁵⁸	South Africa	18 y, NA	Burn, ARDS	NA	Bacteremia	Blood
119	Brink AJ, 1995 []⁵⁸	South Africa	36 y, NA	Traumatic ulcer of leg, cellulitis	NA	Bacteremia	Blood
120	Brink AJ, 1995 []⁵⁸	South Africa	5 y, NA	Traumatic ulcer of leg tetanus	NA	Bacteremia	Blood
121	Brink AJ, 1995 []⁵⁸	South Africa	75 y, NA	Diabetic ulcer of leg	NA	Bacteremia	Blood
122	Brink AJ, 1995 []⁵⁸	South Africa	21 y, NA	Chemical burn on esophagus	NA	Bacteremia	Blood
123	Brink AJ, 1995 []⁵⁸	South Africa	17 y, NA	Cholangitis, liver abscess	NA	Bacteremia	Blood
124	Brink AJ, 1995 []⁵⁸	South Africa	52 y, NA	Epilepsy, aspiration during fit	NA	Bacteremia	Blood
M – male; F – female; NA – not available; SSTI – skin and soft tissue infection; LC – liver cirrhosis; HCC – hepatic cell carcinoma; CKD – chronic kidney disease; HD – hemodialysis; DM – diabetes mellitus; CABG – coronary artery bypass graft surgery; CAD – coronary artery disease; CAPD – Continuous Ambulatory Peritoneal Dialysis; COPD – chronic obstructive pulmonary diseases; CBD – common bile duct; HBV – hepatitis B virus; HCV – hepatitis C virus; AIDS – acquired immune deficiency syndrome; PD – peritoneal dialysis; CHF – congestive heart failure; IE – infective endocarditis; AMI – acute myocardial infarction; MI – myocardial infarction; MR – mitral valve regurgitation; ARDS – adult respiratory distress syndrome; HT – hypertension; SBP – spontaneous bacterial peritonitis; AKI – acute kidney injury; HL – hyperlipidemia; PDA – patent ductus arteriosus; RA – rheumatoid arthritis; TIPS – transjugular intrahepatic portosystemic shunt; GERD – gastroesophageal reflux; MVR – mitral valve replacement; AVR – aortic valve replacement; AF – atrial fibrillation; SSI – skin and soft tissue infection; API Rapid NFT system – system for identifying nonfermentative bacteria; – – – – – – – – – – – – – – – – – – MRSA – methicillin-resistant – – CNS – coagulase negative – – GAS – Group A GGS – Group G – – DRPM – doripenem; CLDM – clindamycin; SBT/CPZ – sulbactam-cefoperazone; CPZ – cefoperazone; MEPM – meropenem; LVFX – levofloxacin; CAZ – ceftazidime; ISP – isepamicin; CZOP – cefozopran; FLUX – flucloxacillin; GM – gentamycin; PIPC – piperacillin; CPFX – ciprofloxacin; CPDX-PR – cefpodoxime proxetil; CEZ – cefazolin; MINO – minocycline; CFPM – cefepime; VCM – vancomycin; DOXY – doxycycline; AMK – amikacin; CTRX – ceftriaxone; FMOX – flomoxef; CMZ – cefmetazole; AMPC/CVA – amoxicillin-clavulanate; CPR – cefpirome; CFX – cefoxitin; ABPC – ampicillin; IMP – imipenem; MPIPC – oxacillin; PIPC/TAZ – piperacillin-tazobactam; DAP – daptomycin; MFLX – moxifloxacin; LVFX – levofloxacin; CTX – cefotaxime; LZD – linezolid; MNZ – metronidazole; ST – trimethoprim-sulfamethoxazole; MDIPC – dicloxacillin; CM – chloramphenicol; NFPC – nafcillin; PC – penicillin; MEZ – mezlocillin; EM – erythromycin; CEPH – cephalosporin; CET – cephalothin; CEF – cefalotin; ABPC/SBT – ampicillin-sulbactam; CFIX – cefixime; OFLX – ofloxacin.
Case No	Shewanella sp.	Co-isolates	Diagnostic method	Portal of entry	Treatment	Antibiotics	Outcome
1			NA	Oral	Debridement, drainage, antibiotics	DRPM+CLDM	Death
2		None	NA	Oral	Drainage, antibiotics	SBT/CPZ→MEPM, SBT/CPZ→LVFX	Survival
3		None	16SrRNA	NA	Drainage, antibiotics	SBT/CPZ	Survival
4			16SrRNA	NA	Drainage, antibiotics	SBT/CPZ	Death
5		None	16SrRNA	Skin lesion	Antibiotics	CAZ+ISP, CZOP, LVFX	Survival
6		None	16SrRNA	Oral	Antibiotics	MEPM, CAZ, LVFX	Survival
7		NA	NA	Respiratory tract	Antibiotics, drainage	FLUX, GM, PIPC, CPFX	Survival
8			Conventional method	NA	Antibiotics	CPDX-PR, CEZ, GM, LVFX, MINO, CFPM	Survival
9			NA	Skin lesion	Antibiotics, drainage	NA	Survival
10		NA	API 20 NE	Skin lesion	Antibiotics, drainage	CFPM	Survival
11		NA	NA	Skin lesion	Antibiotics	CAZ+MEPM+VCM→CAZ+ MEPM+VCM+DOXY→CAZ+GM	Death
12		NA	NA	Catheter	Antibiotics, change of catheter	GM, MEPM	Survival
13		NA	MALDI-TOF, Phoenix NID card	Catheter	Antibiotics	DRPM, AMK	Survival
14		NA	VITEK 2, MALDI-TOF	NA	Drainage, antibiotics	CTRX+CLDM→CTRX	Survival
15		None	NA	Skin lesion	Antibiotics	CTRX, LVFX	Survival
16		NA	NA	NA	antibiotics	CTRX	Survival
17		E.coli	16SrRNA	NA	Antibiotics	FMOX	Survival
18		NA	16SrRNA	NA	Antibiotics	CMZ	Death
19			16SrRNA	NA	Antibiotics	AMPC/CVA	Survival
20		NA	16SrRNA	NA	Antibiotics	CPR	Survival
21		NA	16SrRNA	NA	Antibiotics	CFX	Survival
22		NA	16SrRNA	NA	Antibiotics	AMPC/CVA	Survival
23		NA	16SrRNA	NA	Antibiotics	AMPC/CVA	Death
24		NA	16SrRNA	NA	Antibiotics	ABPC	Survival
25		A baumannii	16SrRNA	NA	Antibiotics	CMZ	Survival
26		spp.	16SrRNA	NA	Drainage, antibiotics	SBT/CPZ→MEPM→ MEPM+VCM	Survival
27		NA	16SrRNA	NA	Antibiotics	MEPM	Survival
28		NA	16SrRNA	oral	Antibiotics	ABPC, CLDM	Survival
29		NA	16SrRNA	Skin lesion	Antibiotics	CEZ→CEZ+CLDM→ CAZ+MINO→CAZ	Survival
30		NA	16SrRNA	oral	Antibiotics	SBT/CPZ, CTRX, LVFX	Survival
31		NA	NA	oral	Antibiotics	IMP, CPFX	Death
32		(MRSA)	16SrRNA	Skin lesion	Antibiotics, drainage	CFPM+VCM→CAZ+CPFX →DOXY	Survival
33		NA	NA	Blood	Antibiotics	MPIPC, PIPC/TAZ	Survival
34			NA	Skin lesion	Antibiotics	LVFX+VCM→DOXY+VCM →DAP+CTRX	Survival
35		NA	NA	NA	Antibiotics, debridement, amputation	PIPC/TAZ+VCM	Survival
36			Conventional method	Skin lesion	Antibiotics, incision, drainage	MFLX, PIPC/TAZ+ VCM, LVFX	Survival
37			MALDI-TOF	Skin lesion	Antibiotics	DAP, CTRX	Survival
38		NA	VITEK, MALDI-TOF	NA	Antibiotics	VCM+MEPM→LVFX	Survival
39		NA	MALDI-TOF, conventional method	NA	Antibiotics	MEPM+LVFX	Survival
40		NA	VITEK 2	NA	Antibiotics	PIPC/TAZ, LVFX	Survival
41		NA	NA	NA	Antibiotics	PIPC/TAZ+VCM→CFPM	Death
42		None	NA	NA	NA	NA	Survival
43		None	NA	NA	Antibiotics	GM+CTRX	Survival
44		Haemolyticus	NA	NA	Antibiotics	LVFX	Survival
45		NA	NA	NA	NA	NA	Survival
46		NA	NA	NA	Antibiotics	NA	Survival
47		NA	NA	NA	Antibiotics	NA	Death
48		NA	NA	NA	Antibiotics	PIPC/TAZ+LVFX	Survival
49		NA	NA	NA	NA	NA	Survival
50		NA	VITEK	NA	Antibiotics	PIPC/TAZ+GM	Death
51		NA	VITEK MS	NA	Antibiotics	CTRX+CPFX	Death
52		NA	MALDI-TOF	Skin lesion	antibiotics, drainage, debridement	PIPC/TAZ+CLDM+AMK →CTX+LZD+MNZ	Survival
53		NA	MALDI-TOF, 16SrRNA	Skin lesion	antibiotics	CTX+AMPC/CVA →CFPM+CPFX	Survival
54	(blood, scrotal tissue), (scrotal fluid)		MALDI-TOF, VITEK 2	NA	Antibiotics, debridement	AMPC/CVA→CAZ+LVFX	Death
55		NA	NA	Skin lesion	Antibiotics	CTRX, CPFX	Survival
56			16SrRNA	NA	Antibiotics	CTX+MNZ→CTX+MNZ+GM →PIPC/TAZ+AMK	Death
57		NA	VITEK 2	Skin lesion	Antibiotics, vulvectomy of mitral valve	CEZ→CFPM+GM	NA
58		(MRSA),	NA	Traumatic route, respiratory tract	Antibiotics, video-assisted thoracoscopic surgery	VCM,ST,CAZ,MPIPC,PIPC/TAZ, CPFX,MNZ,LVFX	Survival
59		NA	Kirby-Bauer disk diffusion	Skin lesion	Antibiotics, debridement	MDIPC→PIPC/TAZ+VCM →PIPC/TAZ	Survival
60		NA	NA	NA	Antibiotics	CTRX+GM	Survival
61		NA	NA	Transplacental	Antibiotics	ABPC+GM→ABPC+ AMK+IMP	Survival
62		NA	16SrRNA	Oral	Antibiotics	CTRX+CPFX	Death
63		NA	16SrRNA	skin lesion, oral	Antibiotics, debridement, amputation	CTRX+DOXY→CPFX	Survival
64			Conventional method	Skin lesion	Antibiotics	ABPC, GM	Survival
65		(CNS),	API 20E	NA	Antibiotics, debridement	GM, CM, ST	Survival
66		Streptococcus pyogenes (GAS)	API 20E	NA	Antibiotics	NFPC, PC, GM	Death
67		NA	API Rapid NFT system	NA	Antibiotics	VCM, GM, MEZ	Survival
68		GGS	API 20E	skin lesion	Antibiotics	NFPC+GM CAZ	Survival
69			API Rapid NFT system	NA	Antibiotics, drainage	ABPC+GM+CLDM	Death
70		NA	API Rapid NFT system	NA	Antibiotics	EM+CAZ	Survival
71		NA	NA	NA	Antibiotics, amputation	CEPH	Survival
72		NA	NA	NA	Antibiotics	PC, CEPH, GM, MPIPC	Death
73		Spp.	NA	NA	Antibiotics	CET	Survival
74		NA	VITEK	Skin lesion	Antibiotics	PIPC, ABPC	Survival
75		NA	API 20NE	NA	NA	NA	NA
76		NA	API 20NE	NA	NA	NA	NA
77			API 20NE	NA	NA	NA	NA
78		NA	Conventional method	NA	Antibiotics, surgical revision	ABPC+GM	Survival
79		NA	API 20NE	skin lesion	antibiotics, amputation	PIPC+GM→ABPC+GM→CEF+GM→CEF	Survival
80		NA	ID 32 GN	NA	Antibiotics	CTX, CLDM, GM	Death
81		NA	API 20NE and VITEK GNI	NA	Antibiotics	CAZ, AMK	Survival
82		NA	VITEK II3 and ID 32 GN	Skin lesion	Antibiotics	ABPC/SBT, ABPC	Survival
83		NA	NA	NA	Antibiotics	AMPC/CVA	Survival
84		NA	16SrRNA	NA	Antibiotics, drainage	IMP→MEPM→CFPM	Survival
85			ID 32 GN	oral	Antibiotics	CEZ+GM→CFIX+DOXY	Survival
86		NA	API 20 NE	NA	Antibiotics, aorto- bi-iliac bypass	CTRX+OFLX→PIPC+GM	Survival
87		Sobria	ID 32 GN	NA	Antibiotics	CEZ+GM+MNZ	Survival
88		M. morganii	ID 32 GN	NA	Antibiotics	CEZ+GM→CPZ	Survival
89			ID 32 GN	NA	Antibiotics	CEZ+GM	Survival
90			ID 32 GN	NA	Antibiotics	CEZ+GM	Death
91	Shewanella putrefaciens		ID 32 GN	NA	Antibiotics	CEZ+GM	Death
92			ID 32 GN	NA	Antibiotics	CEZ+GM+MNZ	Survival
93		NA	NA	NA	Antibiotics	PIPC/TAZ+VCM+ST →MEPM+VCM+ST	Death
94		NA	NA	NA	NA	NA	NA
95		NA	NA	NA	Antibiotics	PIPC/TAZ+VCM→ PIPC/TAZ→PIPC/TAZ+CPFX	NA
96		NA	NA	NA	Antibiotics	VCM+PIPC/TAZ	Survival
97			API 20 NE	NA	NA	NA	Death
98		None	API 20 NE	NA	NA	NA	Death
99			API 20 NE	NA	NA	NA	Survival
100			API 20 NE	NA	NA	NA	Death
101			API 20 NE	NA	NA	NA	Survival
102			API 20 NE	NA	NA	NA	Survival
103			API 20 NE	NA	NA	NA	Survival
104			API 20 NE	NA	NA	NA	Survival
105		None	API 20 NE	NA	NA	NA	Death
106			API 20 NE	NA	NA	NA	Death
107			API 20 NE	NA	NA	NA	Death
108			API 20 NE	NA	NA	NA	Survival
109		None	API 20 NE	NA	NA	NA	Survival
110			API 20 NE	NA	NA	NA	Survival
111		None	API 20 NE	NA	NA	NA	Survival
112		None	API 20 NE	NA	NA	NA	Survival
113		None	API 20 NE	NA	NA	NA	Survival
114			API 20 NE	NA	NA	NA	Survival
115		None	API 20 NE	NA	NA	NA	Survival
116			API 20 NE	NA	NA	NA	Survival
117			API 20 NE	NA	NA	NA	Survival
118			API 20 NE	NA	NA	NA	Death
119			API 20 NE	NA	NA	NA	Survival
120		None	API 20 NE	NA	NA	NA	Survival
121		None	API 20 NE	NA	NA	NA	Survival
122			API 20 NE	NA	NA	NA	Survival
123			API 20 NE	NA	NA	NA	Death
124		None	API 20 NE	NA	NA	NA	Survival
M – male; F – female; NA – not available; SSTI – skin and soft tissue infection; LC – liver cirrhosis; HCC – hepatic cell carcinoma; CKD – chronic kidney disease; HD – hemodialysis; DM – diabetes mellitus; CABG – coronary artery bypass graft surgery; CAD – coronary artery disease; CAPD – Continuous Ambulatory Peritoneal Dialysis; COPD – chronic obstructive pulmonary diseases; CBD – common bile duct; HBV – hepatitis B virus; HCV – hepatitis C virus; AIDS – acquired immune deficiency syndrome; PD – peritoneal dialysis; CHF – congestive heart failure; IE – infective endocarditis; AMI – acute myocardial infarction; MI – myocardial infarction; MR – mitral valve regurgitation; ARDS – adult respiratory distress syndrome; HT – hypertension; SBP – spontaneous bacterial peritonitis; AKI – acute kidney injury; HL – hyperlipidemia; PDA – patent ductus arteriosus; RA – rheumatoid arthritis; TIPS – transjugular intrahepatic portosystemic shunt; GERD – gastroesophageal reflux; MVR – mitral valve replacement; AVR – aortic valve replacement; AF – atrial fibrillation; SSI – skin and soft tissue infection; API Rapid NFT system – system for identifying nonfermentative bacteria; – – – – – – – – – – – – – – – – – – MRSA – methicillin-resistant – – CNS – coagulase negative – – GAS – Group A GGS – Group G – – DRPM – doripenem; CLDM – clindamycin; SBT/CPZ – sulbactam-cefoperazone; CPZ – cefoperazone; MEPM – meropenem; LVFX – levofloxacin; CAZ – ceftazidime; ISP – isepamicin; CZOP – cefozopran; FLUX – flucloxacillin; GM – gentamycin; PIPC – piperacillin; CPFX – ciprofloxacin; CPDX-PR – cefpodoxime proxetil; CEZ – cefazolin; MINO – minocycline; CFPM – cefepime; VCM – vancomycin; DOXY – doxycycline; AMK – amikacin; CTRX – ceftriaxone; FMOX – flomoxef; CMZ – cefmetazole; AMPC/CVA – amoxicillin-clavulanate; CPR – cefpirome; CFX – cefoxitin; ABPC – ampicillin; IMP – imipenem; MPIPC – oxacillin; PIPC/TAZ – piperacillin-tazobactam; DAP – daptomycin; MFLX – moxifloxacin; LVFX – levofloxacin; CTX – cefotaxime; LZD – linezolid; MNZ – metronidazole; ST – trimethoprim-sulfamethoxazole; MDIPC – dicloxacillin; CM – chloramphenicol; NFPC – nafcillin; PC – penicillin; MEZ – mezlocillin; EM – erythromycin; CEPH – cephalosporin; CET – cephalothin; CEF – cefalotin; ABPC/SBT – ampicillin-sulbactam; CFIX – cefixime; OFLX – ofloxacin.

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A Rare Cause of Empyema and Bacteremia Due to Shewanella Species in Alcoholic Cirrhosis Patients: A Case Report and Comprehensive Review of Literature

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