Meropenem and norepinephrine managed a case of chorioamnionitis and septicemia involving Hafnia alveiTreatment of a rare bacterial infection during pregnancy and labor

BackgroundHafnia alvei (H. alvei) is an opportunistic pathogen that rarely causes extraintestinal infections. Chorioamnionitis involving this bacterium, though uncommon, can be life-threatening and rapidly progress to maternal septic shock. However, in the setting of polymicrobial infection—particularly when co-existing with Escherichia coli, a well-recognized pathogen in obstetric sepsis—the severe clinical manifestations cannot be attributed solely to H. alvei.Case summaryWe report a case of a 27-year-old primipara at 33 + 5 weeks of gestation presenting with low-grade fever, lower abdominal pain, and tachycardia. Given high suspicion of intrauterine infection, a multidisciplinary consultation was conducted prior to delivery. The obstetric team diagnosed chorioamnionitis with risks of maternal septic shock and fetal distress. An emergency cesarean section was performed, during which placental surface swab and aerobic and anaerobic blood cultures were collected, followed by initiation of broad-spectrum antimicrobial therapy. Postoperatively, the patient’s condition deteriorated, requiring intensive care and norepinephrine administration to maintain hemodynamic stability. Empirical treatment with meropenem was administered to control infection. The preterm infants suffered from severe infections and survived after 3 weeks of treatment. Blood cultures obtained postoperatively revealed a rare mixed infection of H. alvei and E. coli.ConclusionThis case suggests that although H. alvei is relatively rare in extraintestinal infections, it may become an important pathogen in obstetrics. The rapid progression of the patient’s condition and the lack of definitive treatment guidelines underscore the importance of early clinical recognition and the use of appropriate empirical antibiotic therapy based on local antimicrobial susceptibility patterns. This report supplements the literature on H. alvei infection during pregnancy and confirms the critical role of blood cultures in guiding targeted treatment.