Central venous catheter infection in a child: case report and review of Kluyvera infection in children. (Case Report).

Abstract

Kluyvera is an opportunistic pathogen that can occur in immunosuppressed as well as immunocompetent hosts. We report a case of Kluyvera species infection involving a central venous catheter, and we review the literature on Kluyvera infections in children. Our case demonstrates that removal of the central venous catheter was necessary to eradicate the infection and hasten the resolution of refractory neutropenia. The spectrum of disease due to Kluyvera infection in children includes central venous catheter infection and/or sepsis, urinary tract infection, enteritis, and, in one instance, fatal peritonitis. It is clear on the basis of our case report that uncommon, opportunistic organisms such as Kluyvera can be significant pathogens.

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Kluyvera, a genus in the family Enterobacteriaceae, is a Gram-negative bacillus previously described as an opportunistic pathogen. Kluyvera has been isolated from a variety of human specimens (most commonly sputum, where it is unlikely to be clinically significant). Kluyvera has been found in food, water, soil, sewage, and hospital environments. After Farmer et al's (1) redefinition of the Kluyvera genus in 1981, reports of its isolation in other clinical specimens began to appear. In 1998, West et a1 (2) reviewed 18 cases of Kluyvera infection in humans (primarily in adults). We report a case of this disease in a child and review the literature regarding Kluyvera infection exclusively in children. Our case demonstrates that opportunistic organisms such as Kluyvera species can infect a central venous catheter in an immunosuppressed patient and cause significant illness.

Discussion

In 1981, Farmer et al (1) proposed a new genus for the group of organisms that formerly had been termed enteric Group 8. These organisms were compared with strains of Kluyvera, a group of organisms that had been discovered in Japan and placed in the genus Escherichia. After extensive studies of the organisms, it was found that the isolates did not fit any of the existing species in the family Enterobacteriaceae. Therefore, Farmer et al (1) proposed Kluyvera as a new genus and, on the basis of DNA hybridization, further speciated it into three groups: Kluyvera ascorbate, Kluyvera cryo-crescens, and Kluyvera species Group 3. Kluyvera organisms are Gram-negative, motile bacilli with peritrichous flagella that have a biochemica[ profile similar to that of other Enterobacteriaceae. They are oxidase-negative and catalase-positive, and they ferment glucose. (3) The most common isolates in humans have been found in sputum, although urine, stool, throat swabs, and blood have grown Kluyvera species. (4)

In our review of seven pediatric cases, (4-9) we noted that four isolates were from blood (including our case), four were from urine, and one each were from peritoneal fluid, endo-tracheal aspirate, autopsy lung tissue, and stool (Table 2). No isolates from the central nervous system have been reported in children or adults. (2) The ages of the patients ranged from 3 …