Chronic graft-versus-host disease: Pathogenesis and clinical management.

UNLABELLED: Bacteraemia caused by Kluyvera georgiana is an exceedingly rare clinical entity. As of 2024, only one case had been reported in the world literature: a 67-year-old female patient with recurrent pancreatic cancer undergoing chemotherapy in Japan, in whom the portal of entry for the pathogen was the biliary tract following choledochojejunotomy. We report the second case worldwide and the first from Vietnam, occurring in a 34-year-old male with decompensated cryptogenic cirrhosis. On hospital day 10, the patient developed high-grade fever (39.5°C) with rigors. Two independent blood culture sets drawn from two separate peripheral venous sites both yielded K. georgiana, identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry. Notably, the patient exhibited leukopenia (1.710 cells/μl) with only minimally elevated procalcitonin (0.08 ng/ml), reflecting a blunted inflammatory response characteristic of cirrhosis-associated immune dysfunction. Antimicrobial susceptibility testing demonstrated resistance to ampicillin-sulbactam, ciprofloxacin, cefotaxime, ceftazidime, and trimethoprim-sulfamethoxazole, a substantially broader resistance phenotype than reported in the first case. The patient was treated with intravenous imipenem/cilastatin for 14 days and achieved complete clinical recovery. This case expands the recognized at-risk population for K. georgiana bacteraemia to include patients with decompensated cirrhosis, underscores the critical diagnostic value of early blood cultures when inflammatory markers are unreliable, and highlights the necessity of comprehensive antimicrobial susceptibility testing given the potentially variable resistance phenotypes among K. georgiana strains.

LEARNING POINTS: Kluyvera georgiana bacteraemia can occur in patients with decompensated cirrhosis via gut bacterial translocation, expanding the recognized at-risk population beyond oncologic or chemotherapy-immunosuppressed hosts.Conventional sepsis biomarkers are unreliable in cirrhosis-associated immune dysfunction attenuates both leukocyte and procalcitonin responses. Blood cultures must be drawn whenever clinical suspicion arises, regardless of inflammatory marker values.Antimicrobial susceptibility of K. georgiana is unpredictable. Resistance profiles may vary substantially between strains, mandating comprehensive susceptibility testing and precluding empirical de-escalation based on historical data.