Osteomyelitis Caused by Kluyvera Ascorbata, a Rare Pathogen: First Case Report in Colombia

Abstract

Introduction: Osteomyelitis is a common bone infection, most frequently associated with Staphylococcus aureus and, less commonly, with Gram-negative bacilli, particularly in patients with trauma or previous surgical interventions. In this context, Kluyvera ascorbata, an environmental enterobacterium and commensal organism of the human gastrointestinal tract, has rarely been implicated in clinical infections. Its involvement in osteoarticular infections is exceptionally rare, and according to the literature review, no cases of long-bone osteomyelitis caused by this microorganism have been reported to date.

Case Presentation: A 52-year-old previously healthy man sustained an open proximal tibial fracture and a closed distal tibial fracture following a traffic accident. He underwent surgical management at another institution but subsequently developed a fracture-related infection, requiring multiple debridement procedures and ultimately resulting in knee ankylosis. Six months later, he was referred to the institution with a chronic draining sinus and exposed bone. Radical debridement was performed, and intraoperative tissue cultures yielded Staphylococcus capitis, Serratia marcescens, and Kluyvera ascorbata. Targeted antimicrobial therapy was initiated based on culture results. Two additional surgical procedures were required to achieve infection control and provide soft-tissue coverage using a local flap. The patient experienced a favorable clinical outcome, with complete sinus tract closure, satisfactory soft-tissue coverage, and no evidence of infection recurrence after six months of follow-up.

Conclusion: This report describes the first documented case of chronic tibial osteomyelitis associated with K. ascorbata. This case highlights the importance of intraoperative cultures and the need to consider emerging pathogens in complex osteoarticular infections. Osteomyelitis caused by K. ascorbata is exceptionally rare. Accurate microbiological diagnosis is essential to guide appropriate treatment in complex fracture-related infections.