Something Odd and Something New: A Case of Shewanella putrefaciens Peritonitis and Bacteremia Treated with Intraperitoneal Cefepime

Shewanella spp. is a Gram-negative rod that is normally found in the marine environment and rarely causes illness in humans. Since the late 1970s, cases of Shewanella spp. infection have been described in the literature with a wide array of clinical syndromes and was found to be commonly seen in patients with predisposing conditions. We report a case of a 73 year old woman with end-stage renal disease on peritoneal dialysis who presented with a 3 day history of abdominal pain and was found to have Shewanella putrefaciens peritonitis complicated by bacteremia. She was treated in a novel and successful way by administration of intraperitoneal cefepime. This was further validated by adequate cefepime blood concentrations after drawing a cefepime serum level on day 8 of treatment. To the best of our knowledge, intraperitoneal antibiotic administration to treat both bacterial peritonitis and bacteremia has not been reported in the literature. This treatment approach could potentially be a good precedent for peritoneal dialysis patients needing antibiotics as a less invasive option for antibiotic administration.