Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-25T19:45:59.408Z Has data issue: false hasContentIssue false
  • English
  • Français

Outbreak of Shewanella algae and Shewanella putrefaciens Infections Caused by a Shared Measuring Cup in a General Surgery Unit in Korea

Published online by Cambridge University Press:  02 January 2015

Hyang Soon Oh ,
Kyung Ah Kum ,
Eui-Chong Kim ,
Hoan-Jong Lee ,
Kang Won Choe  and
Myoung Don Oh
Hyang Soon Oh
Affiliation:
Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea
Kyung Ah Kum
Affiliation:
Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea
Eui-Chong Kim
Affiliation:
Departments of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Hoan-Jong Lee*
Affiliation:
Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
Kang Won Choe
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Myoung Don Oh
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
*
Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Republic of Korea ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 8 , August 2008 , pp. 742 - 748
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Holt, HM, Gahrn-Hansen, B, Bruun, B. Shewanella algae and Shewanella putrefaciens: clinical and microbiological characteristics. Clin Microbiol Infect 2005;11:347–352.Google Scholar
2.Nozue, H, Hayashi, T, Hashimoto, Y, et al.Isolation and characterization of Shewanella alga from human clinical specimens and emendation of the description of S. alga Simidu et al., 1990, 335. Int J Syst Bacterial 1992;42:628–634.Google Scholar
3.Vogel, BF, Jørgensen, K, Christensen, H, Olsen, JE, Gram, L. Differentiation of Shewanella putrefaciens and Shewanella alga on the basis of whole-cell protein profiles, ribotyping, phenotypic characterization, and 16S rRNA gene sequence analysis. Appl Environ Microbiol 1997;63:2189–2199.Google Scholar
4.Khashe, S, Janda, JM. Biochemical and pathogenic properties of Shewanella alga and Shewanella putrefaciens. J Clin Microbiol 1998;36:783–787.Google Scholar
5.Vogel, BF, Holt, HM, Gerner-Smidt, P, Bundvad, A, Sogaard, P, Gram, L. Homogeneity of Danish environmental and clinical isolates of Shewanella algae. Appl Environ Microbiol 2000;66:443–448.Google Scholar
6.Chen, YS, Liu, YC, Yen, MY, Wang, JH, Wann, SR, Cheng, DL. Skin and soft-tissue manifestations of Shewanella putrefaciens infection. Clin Infect Dis 1997;25:225–229.Google Scholar
7.Simidu, U, Kita-Tsukamoto, K, Yasumoto, T, Yotsu, M. Taxonomy of four marine bacterial strains that produce tetrodotoxin. Int J Syst Bacterial 1990;40:331–336.Google Scholar
8.King, EO. The Identification of Unusual Pathogenic Gram-Negative Bacteria. Atlanta, GA: National Communicable Disease Center; 1964.Google Scholar
9.Debois, J, Degreef, H, Vandepitte, J, Spaepen, J. Pseudomonas putrefaciens as a cause of infection in humans. J Clin Pathol 1975;28:993–996.Google Scholar
10.Domínguez, H, Vogel, BF, Gram, L, Hoffmann, S, Schaebel, S. Shewanella alga bacteremia in two patients with lower leg ulcers. Clin Infect Dis 1996;22:1036–1039.CrossRefGoogle ScholarPubMed
11.Brink, AJ, van Straten, A, van Rensburg, AJ. Shewanella (Pseudomonas) putrefaciens bacteremia. Clin Infect Dis 1995;20:1327–1332.Google Scholar
12.Iwata, M, Tateda, K, Matsumoto, T, Furuya, N, Mizuiri, S, Yamaguchi, K. Primary Shewanella alga septicemia in a patient on hemodialysis. J Clin Microbiol 1999;37:2104–2105.CrossRefGoogle Scholar
13.Kim, JH, Cooper, RA, Welty-Wolf, KE, Harrel, LJ, Zwadyk, P, Klotman, ME. Pseudomonas putrefaciens bacteremia. Rev Infec Dis 1989;11:97–104.Google Scholar
14.Pagani, L, Lang, A, Vedovelli, C, et al.Soft tissue infection and bacteremia caused by Shewanella putrefaciens. J Clin Microbiol 2003;41:2240–2241.Google Scholar
15.Aspíroz, C, Navarro, C, Aguilar, E, Rodriguez-Andres, M. Bacteremia in an obese patient with cellulitis and chronic ulceration in the lower extremity [in Spanish]. Enferm Infecc Microbiol Clin 2004;22:363–364.CrossRefGoogle Scholar
16.Clément, LF, Gallet, C, Perron, J, Lesueur, A. Infectious cellulitis and Shewanella alga septicemia in an immunocompetent patient [in French]. Ann Dermatol Venereol 2004;131:1095–1097.Google Scholar
17.Wang, IK, Lee, MH, Chen, YM, Huang, CC. Polymicrobial bacteremia caused by Escherichia coli, Edwardsiella tarda, and Shewanella putrefaciens. Chang Gung Med J 2004;27:701–705.Google ScholarPubMed
18.Roger, SD, Chen, SC, Lawrence, S, Sorrell, TC. Pseudomonas putrefaciens bacteraemia in a peritoneal dialysis patient. Nephrol Dial Transplant 1991;6:73.CrossRefGoogle Scholar
19.Heller, HM, Tortora, G, Burger, H. Pseudomonas putrefaciens bacteremia associated with shellfish contact. Am J Med 1990;88:85–86.CrossRefGoogle ScholarPubMed
20.Eschete, ML, Williams, F, West, BC. Pseudomonas putrefaciens and group A beta-hemolytic streptococcus septicemia. Arch Intern Med 1980;140:1533–1534.Google Scholar
21.Schmidt, U, Kapila, R, Kaminski, Z, Louria, D. Pseudomonas putrefaciens as a cause of septicemia in humans. J Clin Microbiol 1979;10:385–387.Google Scholar
22.Vandepitte, J, Debois, J. Pseudomonas putrefaciens as a cause of bacteremia in humans. J Clin Microbiol 1978;7:70–72.Google Scholar
23.Leong, J, Mirkazemi, M, Kimble, F. Shewanella putrefaciens hand infection. Aust NZJ Surg 2000;70:816–817.Google Scholar
24.Papanaoum, K, Marshmann, G, Gordon, LA, Lumb, R, Gordon, DL. Concurrent infection due to Shewanella putrefaciens and Mycobacterium marinum acquired at the beach. Australas J Dermatol 1998;39:92–95.Google Scholar
25.Yohe, S, Fishbain, JT, Andrews, M. Shewanella putrefaciens abscess of the lower extremity. J Clin Microbiol 1997;35:3363.CrossRefGoogle ScholarPubMed
26.Krsnik, I, Arribalzaga, K, Romanyk, J. Shewanella alga bacteremia and associated cellulitis in a patient with multiple myeloma. Haematologia (Budap) 2002;32:79–80.Google Scholar
27.Reddi, GS, Shukl, NP, Singh, KV. Pseudomonas putrefaciens as a cause of infection in burn patient. Indian J Pathol Microbiol 1985;28:303–308.Google Scholar
28.Holt, HM, Sogaard, P, Gahrn-Hansen, B. Ear infections with Shewanella alga: a bacteriologic, clinical and epidemiologic study of 67 cases. Clin Microbiol Infect 1997;3:329–334.Google Scholar
29.Thong, ML. Pseudomonas putrefaciens from clinical material. Southeast Asian J Trop Med Public Health 1976;7:363–366.Google Scholar
30.Süzük, S, Yetener, V, Ergüngör, F, Balaban, N. Cerebellar abscess caused by Shewanella putrefaciens. Scand J Infect Dis 2004;36:621–622.Google Scholar
31.Bulut, C, Ertem, GT, Gokcek, C, Tulek, N, Bayar, MA, Karakoc, E. A rare cause of wound infection: Shewanella putrefaciens. Scand J Infect Dis 2004;36:692–694.Google Scholar
32.Botelho-Nevers, E, Gouriet, F, Rovery, C, et al.First case of osteomyelitis due to Shewanella algae. J Clin Microbiol 2005;43:5388–5390.CrossRefGoogle ScholarPubMed
33.Escudero Sereno, V, Sánchez Castañón, J, Cámara González, T, Lázaro Moreno, T, Romerales Rodríguez, A. Alteromona putrefaciens pleural empyema. An Med Interna 2000;17:666–667.Google Scholar
34.Dhawan, B, Chaudhry, R, Mishra, BM, Agarwal, R. Isolation of Shewanella putrefaciens from a rheumatic heart disease patient with infective endocarditis. J Clin Microbiol 1998;36:2394.Google Scholar
35.Paccalin, M, Grollier, G, le Moal, G, Rayeh, F, Camiade, C. Rupture of a primary aortic aneurysm infected with Shewanella alga. Scand J Infect Dis 2001;33:774–775.Google Scholar
36.Dan, M, Gutman, R, Biro, A. Peritonitis caused by Pseudomonas putrefaciens in patients undergoing continuous ambulatory peritoneal dialysis. Clin Infect Dis 1992;14:359–360.Google Scholar
37.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 199;20:250–278; quiz 279–280.Google Scholar
38.Horan, TC, Emori, TG. Definitions of key terms used in the NNIS System. Am J Infect Control 1997;25:112–116.Google Scholar
39.PulseNet. Department of Health and Human Services. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/pulsenet/. Accessed January 24, 2008.Google Scholar
40.MacDonell, MT, Colwell, RR. Phylogeny of the Vibrionaceae, and recommendation for two new genera, Listonella and Shewanella. Syst Appl Microbiol 1985;6:171–182.Google Scholar
41.Korenevsky, AA, Vinogradov, E, Gorby, Y, Beveridge, TJ. Characterization of the lipopolysaccharides and capsules of Shewanella spp. Appl Environ Microbiol 2002;68:4653–4657.Google Scholar
42.Tsai, TH, You, HY. Necrotizing fasciitis caused by Shewanella putrefaciens in a uremic patient. J Microbiol Immunol Infect 2006;39:516–518.Google Scholar
43.Ivanova, EP, Flavier, S, Christen, R. Phylogenetic relationships among marine Alteromonas-like proteobacteria: emended description of the family Alteromonadaceae and proposal of Pseudoalteromonadaceae fam. nov., Colwelliaceae fam. nov., Shewanellaceae fam. nov., Moritellaceae fam. nov., Ferrimonadaceae fam. nov., Idiomarinaceae fam. nov. and Psychromonadaceae fam. nov. Int J Syst Evol Microbiol 2004;54:1773–1788.Google Scholar