Infections Caused byKluyveraSpecies in Humans

Abstract

Kluyvera is a relatively newly described genus in the family Enterobacteriaceae that infrequently causes infections in humans. The organism has been isolated from various clinical specimens, but its significance has not been clearly established. In fact, it has been regarded alternatively as saprophytic, opportunistic, or pathogenic. Since the redefinition of this genus in 1981, case reports of diverse clinical infections occurring under various host conditions have been published. Here we present a critical review of all Kluyvera infections reported in the literature, along with our experience involving 5 additional cases. Most patients received prompt antimicrobial treatment on the basis of susceptibility testing, and overall the clinical outcomes were good. Antimicrobial agents active against most Kluyvera strains include third-generation cephalosporins, fluoroquinolones, and aminoglycosides. In contrast, the resistance to ampicillin, extended-spectrum penicillins, and first- and second-generation cephalosporins is significant. Kluyvera is a potentially virulent pathogen that deserves aggressive treatment designed with an awareness of the organism's antimicrobial resistance patterns.

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.…”

“…Infection has no specific localization; it may be observed in the urinary tract, gastrointestinal system, soft tissue, central nervous system and blood (6,18). The first patient reported was a newborn who presented with diarrhea which had been lasting for three weeks and completely recovered after 7-day symptomatic treatment (9).…”

“…Kluyvera is a small, peritrichous, mobile, oxidase negative, catalase positive gram negative bacillus and ferments glucose (1,4,5). It is differentiated from other organisms with similar characteristics with its ability to use citrate and malonate, decarboxylate lysine and ornithine and to produce excessive α-ketoglutaric acid during glucose fermantation (6). Validation tests such as usage of ascorbate glucose fermentation at 5°C can differentiation Kluyvera species (2).…”

“…Validation tests such as usage of ascorbate glucose fermentation at 5°C can differentiation Kluyvera species (2). It has no specific virulance factor, but the lipopolysachharide layer and superficial antigens are responsible of virulance as with other bacteriae in the Enterobacteriaceae family (6). Kluyvera is found in water, plants and canalization wastes in the environment, hospital wash basins and animal-derived food (4).…”

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.…”