Infect Chemother.  2010 Dec;42(6):420-423. 10.3947/ic.2010.42.6.420.

Spontaneous Bacterial Peritonitis Caused by Hafnia alvei in a Patient with Liver Cirrhosis

• Jung SK
• Lee JS
• Kim KA
• Kim YD
• Jwa YJ
• Kim NK
• Kwak YG

• KMID: 2170324
• DOI: http://doi.org/10.3947/ic.2010.42.6.420

Abstract

Hafnia alvei is a gram-negative bacillus that is rarely isolated from human clinical specimens and is rarely pathogenic. This organism is an extremely uncommon cause of spontaneous bacterial peritonitis (SBP). We report a case of an 83-year-old male with hepatitis C-associated liver cirrhosis and hepatocellular carcinoma who was diagnosed with SBP caused by H. alvei. He was admitted to an university-affiliated hospital with fever and abdominal pain. There were 2 episodes of SBP during 2 months. Although isolates of H. alvei from ascitic fluid were shown to be susceptible to cefotaxime, responses for cefotaxime treatment were inadequate in both episodes. Therefore, cefotaxime was switched to imipenem in the first episode and to ciprofloxacin in the second, according to the results of antimicrobial susceptibility. After the antibiotics was changed, SBP was resolved.

Keyword

Spontaneous bacterial peritonitis; Hafnia alvei; Liver cirrhosis

MeSH Terms

Abdominal Pain
Aged, 80 and over
Anti-Bacterial Agents
Ascitic Fluid
Bacillus
Carcinoma, Hepatocellular
Cefotaxime
Ciprofloxacin
Fever
Hafnia
Hafnia alvei
Hepatitis
Humans
Imipenem
Liver
Liver Cirrhosis
Male
Peritonitis
Anti-Bacterial Agents
Cefotaxime
Ciprofloxacin
Imipenem

Reference

1. Janda JM, Abbott SL. The genus Hafnia : from soup to nuts. Clin Microbiol Rev. 2006. 19:12–18.

2. Washington JA 2nd, Birk RJ, Ritts RE Jr. Bacteriologic and epidemiologic characteristics of Enterobacter hafniae and Enterobacter liquefaciens. J Infect Dis. 1971. 124:379–386.

3. Thomson KS, Sanders CC, Washington JA 2nd. Ceftazidime resistance in Hafnia alvei. Antimicrob Agents Chemother. 1993. 37:1375–1376.

4. Ramos A, Dámaso D. Extraintestinal infection due to Hafnia alvei. Eur J Clin Microbiol Infect Dis. 2000. 19:708–710.

5. Sheer TA, Runyon BA. Spontaneous bacterial peritonitis. Dig Dis. 2005. 23:39–46.

6. Levison ME, Bush LM. Mandell GL, Bennett JE, Dolin R, editors. Peritonitis and other intra-abdominal infections. Principles and practice of infectious diseases. 2000. 5th ed. Philadelphia: Churchill Livingstone;821–856.

7. Hillebrand DJ, Runyon BA. Spontaneous bacterial peritonitis: keys to management. Hosp Pract (Minneap). 2000. 35:87–90. 96–98.

8. Akcam FZ, Isler M, Tarhan OR, Eroglu HE. Spontaneous bacterial peritonitis due to Hafnia alvei in a patient with peritoneal mesothelioma. Saudi Med J. 2005. 26:151–153.

9. Song W, Kim TK, Park MJ, Lee KM. A case of Hafnia alvei peritonitis with septicemia. Korean J Clin Microbiol. 2001. 4:139–141.

10. Barry JW, Dominguez EA, Boken DJ, Preheim LC. Hafnia alvei infection after liver transplantation. Clin Infect Dis. 1997. 24:1263–1264.

11. Conte M, Castagnola E, Venzano P, Tasso L, Giacchino R. Bacteremia caused by Hafnia alvei in a human immunodeficiency virus-infected child. Pediatr Infect Dis J. 1996. 15:182–183.

12. Stock I, Rahman M, Sherwood KJ, Wiedemann B. Natural antibiotics susceptibility patterns and biochemical identification of Escherichia albertii and Hafnia alvei strains. Diagn Microbiol Infect Dis. 2005. 51:151–163.

13. Nadjar D, Rouveau M, Verdet C, Donay L, Herrmann J, Lagrange PH, Philippon A, Arlet G. Outbreak of Klebsiella pneumoniae producing transferable AmpC-type beta-lactamase (ACC-1) originating from Hafnia alvei. FEMS Microbiol Lett. 2000. 187:35–40.

14. Girlich D, Naas T, Bellais S, Poirel L, Karim A, Nordmann P. Heterogeneity of AmpC cephalosporinases of Hafnia alvei clinical isolates expressing inducible or constitutive ceftazidime resistance phenotypes. Antimicrob Agents Chemother. 2000. 44:3220–3223.

15. Günthard H, Pennekamp A. Clinical significance of extraintestinal Hafnia alvei isolates from 61 patients and review of the literature. Clin Infect Dis. 1996. 22:1040–1045.

16. Savini V, Catavitello C, Di Bonaventura G, Talia M, Balbinot A, Febbo F, Manna A, Piccolomini R, D'Antonio D. VITEK 2 failure in screening Hafnia alvei inducible beta-lactam resistance. J Hosp Infect. 2008. 69:396–398.

17. Parsi MA, Atreja A, Zein NN. Spontaneous bacterial peritonitis: recent data on incidence and treatment. Cleve Clin J Med. 2004. 71:569–576.

18. Runyon BA, McHutchison JG, Antillon MR, Akriviadis EA, Montano AA. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. A randomized controlled study of 100 patients. Gastroenterology. 1991. 100:1737–1742.