Hafnia alvei: A new pathogen in open fractures

Abstract

Background: Deep infection following open both bone forearm fractures is a rare complication. Prophylactic antibiotic regimens are targeted at the most common pathogens, which include primarily Staph aureus followed by gram-negative bacteria. Hafnia alvei is an unusual pathogen that is rarely pathogenic in humans and has never been reported as a cause of infection following open fracture.

Methods: We present a 12-year-old male with an open forearm fracture who developed a late deep infection. Cultures grew only Hafnia alvei. The patient was treated with debridement, placement of antibiotic beads, and ciprofloxacin.

Results: At 6 months following the initial debridement, the patient had no clinical evidence of infection and regained full function of the affected forearm without any residual deficits.

Conclusions: This is the first report of deep infection following an open forearm fracture owing to Hafnia alvei, a pathogen rarely responsible for human infection.

Keywords: Forearm fracture; Hafnia alvei; Open fracture; Osteomyelitis.

Fig. 1

AP and lateral radiographs of the forearm at the initial injury.

Fig. 2

AP and lateral radiographs of the forearm at a) 2 weeks post-op, and b) at union.

Fig. 3

AP and lateral radiographs of the forearm at the time of infection.

Fig. 4

MRI at the time of infection.