title: Kluyvera co-infection in two solid organ transplant recipients: an emerging pathogen or a colonizer bystander?
abstract: Kluyvera species are opportunistic, gram-negative bacilli in the family Enterobacteriaceae. Ordinarily occurring as a commensal, Kluyvera have been reported to cause serious infections in immunosuppressed and immunocompetent hosts, causing diarrhea, urinary infections, peritonitis, and cholecystitis. We report Kluyvera infections in 2 solid organ transplant recipients. An 18-year-old female with alpha-1 antitrypsin deficiency underwent living donor liver transplantation and presented 6 months later with a liver abscess. The abscess aspirate grew mixed organisms including Kluyvera cryocrescens. A 22-year-old female with renal failure secondary to focal segmental glomerulosclerosis underwent a deceased donor kidney transplant and presented 3 months later with pyelonephritis; the urine culture grew Kluyvera ascorbata. Both patients improved only when their antibiotic coverage was broadened to include Kluyvera. The isolation of Kluyvera as a pathogen in transplant patients emphasizes that this commensal organism may be virulent in this patient population.
authors.affiliation: Division of Transplantation Medicine, Mayo Clinic Hospital, Phoenix, AZ 85054, USA.
authors.forename: R
authors.initials: R
authors.lastname: Cheruvattath
authors.forename: V
authors.initials: V
authors.lastname: Balan
authors.forename: R
authors.initials: R
authors.lastname: Stewart
authors.forename: R L
authors.initials: RL
authors.lastname: Heilman
authors.forename: D C
authors.initials: DC
authors.lastname: Mulligan
authors.forename: S
authors.initials: S
authors.lastname: Kusne
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D044086:Kluyvera / Q000472:pathogenicity; D008100:Liver Abscess / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D011704:Pyelonephritis / Q000209:etiology*; D016896:Treatment Outcome; D014774:Virulence
chemical_list: D000900:Anti-Bacterial Agents