Clinically Significant Kluyvera Infections

Abstract

To determine the clinical significance of Kluyvera isolates at our institution, we retrospectively analyzed clinical microbiology data from January 1999 to September 2003. We identified 11 isolates classified as Kluyvera ascorbata, 7 of which were considered clinically significant pathogens: 3 cases represented urinary tract infections; 2, bacteremia; 1, a soft tissue infection of the finger; and 1, acute appendicitis with a subsequent intra-abdominal abscess. The age distribution of patients was wide, ranging from 2 months to 73 years. Antimicrobial susceptibility studies of the clinically significant and non-clinically significant Kluyvera isolates showed susceptibility patterns similar to those reported in the medical literature, namely trends of resistance to ampicillin and first- and second-generation cephalosporins. Of the 4 non-clinically significant isolates in our study, 1 was resistant to ciprofloxacin, a finding reported in only 1 other isolate of Kluyvera in the medical literature. Patient outcome after treatment with third-generation cephalosporins and aminoglycosides in the 7 clinically significant cases was good, with no long-term sequelae. The potential virulence of K ascorbata highlights the need for heightened scrutiny of its antimicrobial susceptibility patterns for adequate clinical treatment.

Kluyvera ascorbata infections in children: a case series

“…It has been reported that three (K. ascorbata, K. cryocrescens, K.georgiana) of the four types demonstrated until the present time cause infection in humans and the most common among these is K. ascorbata as in our patient series (8). While K. ascorbata was isolated in 11 of 19 pediatric patients in the literature and K. cryocrescens was isolated in three, typing could not be done in five (3)(4)(5)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). In Table 1, all pediatric cases in which Kluyvera infection was reported is summarized.…”

“…On the 10 th day of treatment, the clinical findings worsened and the body temperature increased again (38,8°C). His laboratory findings were as follows: hemoglogin 9.6 g/dL, leukocytes: 20 500/mm 3 , platelets: 294 000/mm 3 and C-reactive protein: 13.6 mg/dL. Since the findings on the chest x-ray improved, cefepime was discontinued after obtaining blood culture meropenem, vancomycin and amikacin treatments were started considering the hospitalization of the patient.…”

“…Therefore, the patient was referred to our hospital. His laboratory findings were as follows: hemoglobin: 11,1 g/dL, WBC: 11 500/mm 3 , platelets: 338 000/mm 3 and C-reactive protein: 3.2 mg/dL. A drainage tube was placed for collection and ampicillin-sulbactam, amikacin and ornidazole treatment was initiated.…”

“…It was shown to be a new member of the Enterobacteriaceae family using molecular methods and deoxyribonucleic acid (DNA) hybridization technique in 1981 (2). There are four Kluyvera species which have been defined until the present time including K. ascorbata, K. cryocrescens, K. georgiana and K. cochleae (3). Kluyvera is a small, peritrichous, mobile, oxidase negative, catalase positive gram negative bacillus and ferments glucose (1,4,5).…”

Isolation of a Zoonotic Pathogen Kluyvera ascorbata from Egyptian Fruit-Bat Rousettus aegyptiacus

“…There are three strains of Kluyvera: Kluyvera ascorbata, K. cryocrescens and Kluyvera species group 3, as reported by Farmer et al [4]. K. ascorbata is the type of species for the genus that was not only been isolated and reported from different cases of human clinical infections: urinary tract infection, sepsis and bacteremia, diarrhea, soft tissue infection, cholecystitis, peritonitis and intra-abdominal abscess, pancreatitis, mediastinitis, urethrorectal fistula [1,3,[11][12][13], but was also isolated from subclinically infected primate Madagascan lemurs [10]. K. ascorbata is an uncommon but clinically very important pathogen.…”