IDCases · 2026
Multidrug-resistant Shewanella putrefaciens isolated from ascitic fluid in a patient with decompensated cirrhosis: A case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Wang Ziheng, Qin Jiaxu, Kong Rui, Zhang Peng
Аннотация
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.
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.