title: Skin and Soft Tissue Infections due to Shewanella algae - An Emerging Pathogen.
abstract: BACKGROUND
  Shewanella spp. are emerging human pathogens, the predominant species being Shewanella algae. Shewanella skin and soft tissue infections are more commonly seen in immunocompromised patients with a pre-existing cutaneous ulcer and most often associated with exposure to marine environments.
  
  
  OBJECTIVE
  The study was conducted to investigate the epidemiological and clinical characteristics of Shewanella skin and soft tissue infections (SSTIs) for a period of five years.
  
  
  METHODS
  All Gram-negative non-fermenting motile isolates which produced pigmented colonies and positive for oxidase and H2S were further identified with Vitek 2 system.
  
  
  RESULTS
  A total of 16 patients with SSTIs due to Shewanella species were identified during the period from 2010 to 2014. Majority of patients were urban, elderly and fisher men. Shewanella algae (n=12, 75%) was the predominant isolate. Skin or mucosal portal of entry was found in all patients and seawater contact was recorded in 56.25% of the patients. 81% of infections were polymicrobial, common concomitant pathogens being gut and marine flora. Peripheral vascular diseases were the predominant risk factors with comorbidities like diabetes, hypertension and hepatobiliary diseases. Third generation cephalosporins, meropenem and gentamicin were the most effective antibiotics while two of the isolates were multidrug resistant. 75% of the infected patients recovered completely and three patients died of complications.
  
  
  CONCLUSIONS
  Shewanella algae should be considered as an emerging pathogen of SSTIs mainly in patients with chronic ulcers and at times be multidrug resistant. These infections have a good clinical outcome if prompt medical, surgical and supportive treatment is offered.
authors: Clinical Associate Professor, Department of Microbiology, Amrita Institute of Medical Sciences and Research Institute , Kochi, Kerala, India .
authors: Jampala
authors: J
authors: Srinivas
authors: Senior Resident, Department of Microbiology, Amrita Institute of Medical Sciences and Research Institute , Kochi, Kerala, India .
authors: Meera
authors: M
authors: Pillai
authors: Senior Scientist, Department of Nanosciences, Amrita Institute of Medical Sciences and Research Institute , Kochi, Kerala, India .
authors: Vivek
authors: V
authors: Vinod
authors: Clinical Professor, Department of Microbiology, Amrita Institute of Medical Sciences and Research Institute , Kochi, Kerala, India .
authors: R Kavitha
authors: RK
authors: Dinesh
keywords: Comorbidities; Infections; Marine flora; Non-fermenters; Polymicrobial; Shewanella species