SKIN AND SOFT-TISSUE MANIFESTATIONS OF SHEWANELLA-PUTREFACIENS INFECTION

Shewanella putrefaciens, a saprophytic gram-negative rod, is infrequen tly recovered from clinical specimens. Although a number of clinical s yndromes have been attributed to S. putrefaciens, the pathogenic role of this agent remains largely undefined. We report 16 cases of S. putr efaciens infection that occurred at the Veterans General Hospital-Kaoh siung in Taiwan between 1990 and 1995. S. putrefaciens infection was a ssociated with a wide clinical spectrum including bacteremia/septicemi a, skin and soft-tissue infection, biliary tract infection, peritoniti s, and empyema. Five of our patients had skin and soft-tissue manifest ations, including fulminant periorbitofacial cellulitis, dacryocystiti s, perineal abscess, finger abscess, and postcholecystectomy wound inf ection. These clinical features deviated from the chronic ulcers or in fected burns of the lower extremities that have been described in prev ious reports. Seven (44%) of our 16 patients had bacteremia/septicemia , and all seven had underlying hepatobiliary diseases. S. putrefaciens was isolated in mixed cultures of specimens from 14 patients; Escheri chia coli was the most common coisolate. Hepatobiliary diseases and ma lignancy were the major predisposing factors for S. putrefaciens infec tion of the biliary tract and S. putrefaciens bacteremia/septicemia.