An unexpected pathogen: urinary tract infection caused by hafnia alvei in a newborn

CASE REPORTS

An Unexpected Pathogen: Urinary Tract Infection Caused by Hafnia alvei in a Newborn

Samet Benli¹, Derya Çağıran², Ezgi Ece Saruhan Karpuz², Zeynep Gulseli Vural², Hacer Yavuz², Sibel Laçinel Gürlevik³.

¹Neonatology Department, Cengız Gökçek Maternıty And Chıld Dıseases Hospıtal, Gaziantep, Turkey,
²Pediatrics Department, Cengız Gökçek Maternıty And Chıld Dıseases Hospıtal, Gaziantep, Turkey,
³Pediatric Infectious Diseases Department, Cengız Gökçek Maternıty And Chıld Dıseases Hospıtal, Gaziantep, Turkey.

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Abstract
Hafnia alvei is a gram-negative bacterium that has been rarely reported as a cause of human infections. Its occurrence as an etiologic agent of urinary tract infection in the neonatal period is particularly uncommon. In this report, we present a case of a 13-day-old male neonate who was admitted with fever and irritability and was found to have Hafnia alvei growth in the urine culture. As the microorganism was susceptible to gentamicin, the patient was treated with gentamicin for seven days, resulting in complete resolution of clinical and laboratory findings. This case highlights that rare pathogens should be considered in the evaluation of urinary tract infections in the neonatal period and that the prognosis is favorable with appropriate antibiotic therapy.

Why this article important?

This case report is noteworthy as it demonstrates that Hafnia alvei, a pathogen rarely encountered in the neonatal period, may present as a urinary tract infection in term infants. In the literature, neonatal H. alvei infections have predominantly been described as sepsis or gastrointestinal involvement, and presentations in the form of urinary tract infections remain extremely limited. Therefore, this case is valuable in raising clinical awareness and reminding clinicians to consider uncommon pathogens in neonatal infectious evaluations. Furthermore, the favorable outcome achieved through culture- and susceptibility-guided antibiotic therapy highlights the importance of timely recognition and appropriate management of such rare infections.

Summary of article

This case report highlights Hafnia alvei as an uncommon causative pathogen of urinary tract infection in the neonatal period. Although typically considered part of the normal gastrointestinal flora and classified as an opportunistic organism, H. alvei may occasionally act as a primary urinary pathogen even in term neonates without identifiable risk factors. In the presented case, the diagnosis was established through urine culture, and clinical recovery was achieved with targeted gentamicin therapy. Beyond emphasizing the importance of considering rare pathogens in febrile neonatal presentations, this case also illustrates the value of obtaining appropriate microbiological samples prior to antibiotic initiation. Early culture-based antibiotic selection not only allows for effective treatment but also helps avoid unnecessary broad-spectrum antibiotic exposure and supports antimicrobial stewardship. Overall, the case contributes to the limited literature on neonatal H. alvei infections and highlights its clinical relevance.

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