ABSTRACT
Shewanella algae is an opportunistic Gram-negative bacillus primarily found in marine environments. It can cause a range of infections in humans, from superficial soft tissue infections to more severe conditions like bacteremia, otitis, and hepatobiliary infections. While infections are rare, they can be significant, leading to complications such as sepsis and tissue necrosis. We present the case of severe cellulitis caused by Shewanella in an 88-year-old patient with multiple comorbidities. Following a blue crab pinch and consequent saltwater exposure, the patient developed severe cellulitis, sepsis, delirium, and atrial fibrillation. Despite these complications and the patient's age, a prompt diagnosis and a combination of antibiotic treatments led to a successful recovery. This case is notable for its illustration of the potential severity and diverse clinical presentation of Shewanella infections. It highlights the importance of considering Shewanella as a possible pathogen in cases of saltwater exposure and teaches management in elderly, multi-morbid patients.
ABSTRACT
OBJECTIVES: We investigated whether advanced age affects peri-operative outcomes after robotic-assisted pulmonary lobectomies. MATERIALS AND METHODS: We retrospectively analyzed patients who underwent robotic-assisted lobectomy by one surgeon over a 5-year period. Rates of postoperative complications were compared according to age group. Other outcomes, such as intraoperative complications, hospital length of stay (LOS), and in-hospital mortality, were also compared. RESULTS: A total of 287 patients were included (mean age 67.1yr). Group A had 65 patients of advanced age≥75yr (range 75-87yr; 37 men, 28 women); Group B had 222 patients aged <75yr (range 29-74yr; 95 men, 127 women). Group A had 10/65 (15.4%) patients with robotic-related intraoperative complications, compared to 10/222 (4.5%) for Group B (p=0.002), with the most frequent intraoperative complications being bleeding from a pulmonary vessel (10.8% vs. 4.5%, p=0.06), bronchial injury (3.1% vs. 0.9%, p=0.18), and injury to the phrenic or recurrent laryngeal nerve (1.5% vs. 0.4%, p=0.33). There were 28/65 (43.1%) patients in Group A with postoperative complications compared to 76/222 (34.2%) in Group B (p=0.19). While operative times were similar (p=0.42), Group A had longer median hospital LOS of 6±0.9days compared to 4±0.3days for Group B (p=0.02). CONCLUSION: While younger patients have lower risk of robotic-related intraoperative complications and shorter hospital LOS, elderly patients do not have increased overall or emergent conversion rates to open lobectomy, overall postoperative complications rates, or in-house mortality compared to younger patients. Thus, robotic-assisted pulmonary lobectomy is feasible and relatively safe for patients of advanced age.
