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Outbreak of Shewanella algae and Shewanella putrefaciens Infections Caused by a Shared Measuring Cup in a General Surgery Unit in Korea

Published online by Cambridge University Press:  02 January 2015

Hyang Soon Oh
Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea
Kyung Ah Kum
Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea
Eui-Chong Kim
Departments of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Hoan-Jong Lee*
Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
Kang Won Choe
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Myoung Don Oh
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Republic of Korea (



To control an outbreak of Shewanella algae and S. putrefaciens infections by identifying the risk factors for infection and transmission.


Matched case-control study.


A university-affiliated tertiary acute care hospital in Seoul, Republic of Korea, with approximately 1,600 beds.


From June 20, 2003, to January 16, 2004, a total of 31 case patients with Shewanella colonization or infection and 62 control patients were enrolled in the study.


Requirement to use single-use measuring cups and standard precautions (including hand washing before and after patient care and use of gloves).


S. algae or S. putrefaciens was isolated from blood, for 9 (29.0%) of 31 patients who acquired one of the organisms; from bile, for 8 (25.8%), and from ascitic fluid, for 8 (25.8%). The attack rate of this outbreak was 5.8% (31 patients infected or colonized, of 534 potentially exposed on ward A) and the pathogenicity of the two species together was 77.4% (24 patients infected, of 31 who acquired the pathogens). The estimated incubation period for Shewanella acquisition was 3–49 days. Using logistic analysis, we identified the following risk factors: presence of external drainage catheters in the hepatobiliary system (odds ratio [OR], 20; P < .001), presence of hepatobiliary disease (OR, 6.4; P < .001), admission to the emergency department of the hospital (OR, 2.9; P = .039), wound classification of “contaminated” or “dirty or infected” (OR, 16.5; P = .012), an American Society of Anesthesiologists score of 3 or higher (OR, 8.0; P = .006), duration of stay in ward A (OR, 1.1; P < .001), and, for women, an age of 60–69 years (OR, 13.3; P = .028). A Shewanella isolate was recovered from the surface of a shared measuring cup, and 12 isolates of S. algae showed the same pulsed-field gel electrophoresis pattern.


This Shewanella outbreak had a single-source origin and spread by contact transmission via a contaminated measuring cup. Shewanella species are emerging as potentially serious human pathogens in hospitals and could be included in hospital infection surveillance systems.

Original Article
Copyright © The Society for Healthcare Epidemiology of America 2008

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