A rare case of opportunistic Kluyvera bloodstream infection in a pediatric patient with supratentorial ependymoma

Abstract

A 2.5-year-old girl with a history of surgically resected supratentorial ependymoma WHO grade 3 developed a central line-associated bloodstream infection (CLABSI) during hospitalization for intensity-modulated radiation therapy (IMRT). The patient had a peripherally inserted central catheter (PICC) line placed for management and developed fever five days post-insertion. Blood cultures from both PICC line and peripheral vein grew Kluyvera species, a rare gram-negative opportunistic pathogen from the Enterobacteriaceae family. The organism was susceptible to several antibiotics including piperacillin-tazobactam, carbapenems and aminoglycosides. The infected PICC line was removed, and the patient received systemic antibiotic therapy with piperacillin-tazobactam. Clinical improvement was observed within three days, with complete recovery from the infection achieved after five days of treatment. This case highlights the potential for Kluyvera spp. to cause CLABSI in immunocompromised pediatric oncology patients. It underscores the importance of prompt recognition, appropriate antibiotic therapy, and heightened surveillance and infection prevention strategies in this vulnerable population.

Keywords: Kluyvera species, Central line-associated bloodstream infection, Pediatric oncology, Ependymoma, PICC line, Opportunistic pathogen