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Background   Shewanella  species are emerging pathogens that can cause severe hepatobiliary, skin and soft tissue, gastrointestinal, respiratory infections, and bacteremia. Here we reported the largest case series of infections caused by  Shewanella  species.    Aim  To identify the clinical features and risk factors predisposing to  Shewanella  infections. To evaluate resistance pattern of  Shewanella  species and appropriateness of antibiotic use in the study cohort.    Methods  Patients admitted to a regional hospital in Hong Kong with  Shewanella  species infection from April 1, 2010 to December 31, 2020 were included. Demographics, antibiotics, microbiology, and outcomes were retrospectively analyzed.    Findings  Over the 10 years, we identified 128 patients with  Shewanella  species infection. 61.7% were male with a median age of 78 (IQR 65–87). Important underlying diseases included hepatobiliary diseases (63.3%), malignancy (26.6%), chronic kidney disease or end-stage renal failure (25.8%), and diabetes mellitus (22.7%). Hepatobiliary infections (60.4%) were the most common clinical manifestation. Majority (92.2%) were infected with  Shewanella algae , while 7.8% were infected with  Shewanella putrefaciens . The identified organisms were usually susceptible to ceftazidime (98.7%), gentamicin (97.4%), cefoperazone-sulbactam (93.5%) and ciprofloxacin (90.3%). Imipenem-susceptible strains were only present in 76.6% of isolates.    Conclusion  This largest case series suggested that  Shewanella  infections are commonly associated with underlying comorbidities, especially with hepatobiliary diseases and malignancy. Although  Shewanella species  remained largely susceptible to third and fourth generation cephalosporins and aminoglycosides, carbapenem resistance has been on a significant rise.

Emerging Infections Due to Shewanella spp.: A Case Series of 128 Cases Over 10 Years