Ventilator-associated pneumonia due to Shewanella putrefaciens

Purpose. The first reported U.S. case of ventilator-associated pneumonia evidently caused by Shewanella putrefaciens is described. Summary. A 39-year-old man with severe head trauma was found face down and unresponsive in a river after a watercraft accident. After being resuscitated and transferred to the intensive care unit, the patient received treatment for a subarachnoid hemorrhage and spinal injuries. The patient was also found to have decreased breath sounds bilaterally. On hospital day 7, bronchoalveolar lavage was performed due to acute febrile illness and thick pulmonary secretions. The patient was treated empirically with i.v. vancomycin and cefepime. The culture results suggested pneumonia due to methicillin-sensitive Staphylococcus aureus and colonization with Pseudomonas aeruginosa. The vancomycin and cefepime were replaced with nafcillin, after which the pneumonia resolved. The patient continued to be febrile, with leukocytosis on hospital day 14. A subsequent bronchoalveolar lavage culture performed that day revealed the presence of S. putrefaciens. According to the culture and susceptibility results, S. putrefaciens was resistant to ampicillin sulbactam and exhibited sensitivity to cefepime, piperacillin, piperacillin tazobactam, gentamicin, ciprofloxacin, levofloxacin, and meropenem. The patient received a 14-day course of cefepime, eliminating any further sign of the pathogen. Over the next two months, the patient's condition continued to improve, and he was eventually discharged to a rehabilitation facility. Conclusion. A 39-year-old man developed ventilator-associated pneumonia evidently caused by S. putrefaciens. The pneumonia resolved after treatment with cefepime.