Title : Kluyvera cryocrescens central line associated bacteremia in a hemodialysis patient: A case report and review of literature
Abstract:
Kluyvera sp., an opportunistic Gram-negative bacillus found in clinical specimens such as sputum, urine, bile, peritoneal fluid, and blood, rarely causes significant infections. This case report manages a rare Kluyvera cryocrescens bacteremia in a female patient with chronic kidney disease due to IgA Nephropathy undergoing hemodialysis, highlighting the critical recognition of rare pathogens in patients with complex medical histories.
A 29-year-old female with end-stage kidney disease from IgA Nephropathy, polycystic ovary syndrome, and hypertension presented with weakness, lightheadedness, and generalized tremors three days post-hemodialysis. Despite the lack of fever or hemodynamic instability, symptoms such as weakness, malaise, pleuritic chest pain, and pain at the IJ catheter site suggested a systemic infection. Blood cultures from peripheral and central lines were obtained. Empiric therapy with Piperacillin-tazobactam was initiated. The isolates were identified as Kluyvera cryocrescens, sensitive to the administered antibiotics, which were therefore continued. The IJ catheter was temporarily removed and later re-inserted at a different site. After clinical improvement, IV antibiotics were switched to oral Ciprofloxacin, resulting in symptom resolution and the patient's stable discharge.
Kluyvera cryocrescens poses a risk for opportunistic infections in immunocompromised individuals. Though this infection may be uncommon, documented cases reveal a spectrum of clinical presentations, such as peritonitis, cholecystitis, wound infections, and complications related to indwelling devices. Our literature review, supported by findings from the present case, highlights bacteremia in the context of indwelling catheters as a notable risk factor. Empirical therapy, guided by the organism's susceptibility profile, typically include extended-spectrum cephalosporins, carbapenems, fluoroquinolones, and tetracyclines. Furthermore, this case emphasizes the importance of vigilance for infectious risks associated with hemodialysis and indwelling catheters, advocating for a cautious approach in similar patient populations.
