Interdisciplinary Neurosurgery (Dec 2021)
Shewanella putrefaciens ventriculitis in a patient with an external ventricular drainage system: A case report
Abstract
Introduction: Shewanella spp. are Gram-negative, motile bacilli, whose most important phenotypic characteristic is the production of hydrogen sulphide. The clinically relevant pathogens to humans are S. algae and S. putrefaciens. There have been a variety of clinical cases published including bacteremia, skin, soft tissue infections, pneumonia, external drainage systems and brain abscesses. Catheter-related ventriculitis is associated with significant morbidity, especially with gram-negative organisms. Ventriculitis by S. putrefaciens is extremely rare, with only one case reported in medical literature. Furthermore, hospital acquired S. putrefaciens infections are extraordinary. Case report: A 45- year-old female presented with 36 hours of worsening headaches. During her initial assessment hydrocephalous diagnosis was met and removal and replacement of a new left precoronal ventriculoperitoneal shunt was performed though the same burr hole. Unfortunately, dysfunction of the newly placed shunt and newly evidenced fever. Removal of the previous ventriculoperitoneal shunt and placement of an external ventricular drain (EVD) was done. Consecutively newly drawn cerebrospinal fluid sent to cultivate developed positive cultures to Shewanella putrefaciens. Due to its high resistance to most antibiotics, colistin was used until complete eradication of infection was achieved. Observations: We found that having an external ventricular drainage system augments the possibility of acquiring an infection by Shewanella putrefaciens. Although the patient sustained a highly resistant bacterium, the patient's ventriculitis was resolved. Additionally, the reason why our patient sustained an infection to this water-borne bacterium is still unclear. No history of immunosuppressive state or chronic illness was detected in our patient. Here we describe an extremely rare hospital-acquired ventricular infection caused by S. putrefaciens in a Mexican woman with an external ventricular drain. To the best of our knowledge, this is the first case reported in medical literature in the Western Hemisphere.
