Hafnia alvei Infections: Clinical Characteristics and Therapeutic Challenges of an Uncommon Pathogen

Hafnia alvei is a rare opportunistic pathogen of the Enterobacteriaceae family, typically regarded as a gastrointestinal commensal. However, it has been implicated in serious infections, particularly in immunocompromised patients, posing diagnostic and therapeutic challenges. We present the case of a 70-year-old woman with a history of cryptogenic cirrhosis postliver transplant, complicated by sepsis and advanced pancreatic adenocarcinoma under palliative care. She developed a urinary tract infection caused by Hafnia alvei and Klebsiella oxytoca, confirmed by cultures. Despite targeted antibiotic therapy with vancomycin and ciprofloxacin, her condition deteriorated, leading to death due to oncologic disease progression. This case underscores the pathogenic potential of Hafnia alvei, its role in polymicrobial infections, and the importance of antimicrobial susceptibility testing. Raising awareness of this under-recognized pathogen is crucial to improving outcomes in vulnerable populations.