Leclercia adecarboxylata Bacteremia without a Focus in a Non-Immunosuppressed Patient

Abstract

Patient: Female, 74-year-old Final Diagnosis: Leclercia adecarboxylata bacteremia Symptoms: Cough • fever • shock • shortness of breath Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Microbiology and Virology Objective: Rare disease Background: Leclercia adecarboxylata is a gram-negative rod, which is normally found in water and food. It is an emerging pathogen that affects immunocompromised patients, including patients with hematological malignancies or those receiving chemotherapy. Generally, L. adecarboxylata is considered a low-virulence pathogen with an excellent susceptibility profile, but some strains may be resistant to multiple antibiotics, such as β-lactams. Moreover, L. adecarboxylata is usually isolated as a part of polymicrobial cultures in immunocompetent individuals, but there have been cases where it was the only isolate. Case Report: A 74-year-old woman who was non-immunosuppressed and had multiple comorbidities was admitted with acute decompensated heart failure due to pneumonia. She was treated with multiple courses of antibiotics including amoxicillin-clavulanate and ciprofloxacin for pneumonia, but her infection worsened, and she had cardiopulmonary arrest. After resuscitation, she was stable for several days but suddenly became confused and hypotensive. The septic screen showed L. adecarboxylata bacteremia without a clear source, which was treated successfully with meropenem for 14 days. After the meropenem course, the patient developed diarrhea and was found to have severe Clostridium difficile infection. She did not respond to oral vancomycin and intravenous metronidazole and died. Conclusions: This case illustrated an infection in a non-immunosuppressed individual by an organism that is considered an opportunistic pathogen, mainly affecting immunocompromised patients. The patient’s blood culture grew L. adecarboxylata , which was sensitive to all antibiotics but resolved with meropenem treatment. Owing to increasing L. adecarboxylata infections, we recommend further studies to understand the organism’s pathogenesis, risk factors, and resistance pattern.

Leclercia adecarboxylata as Emerging Pathogen in Human Infections: Clinical Features and Antimicrobial Susceptibility Testing

“…L. adecarboxylata is implicated in cases which involve endocarditis [15,16], catheterrelated bacteremia [10,17,18], bacteremia and cellulitis [5,6,9,19,20], urinary tract infections [6,21], pneumonia [5,22] and bacterial peritonitis, especially in peritoneal dialysis patient [7,[11][12][13][14], which was the case for the majority of our clinical presentations. L. adecarboxylata was most often found as a monomicrobial infection in immunocompromised patients, and as part of a polymicrobial infection in immunocompetent patients [5,12].…”

Colonisation of extended spectrum β-lactamase- and carbapenemase-producing bacteria on hospital surfaces from low-/middle-income countries

“…adecarboxylata has been implicated in paediatric infections and sepsis 44,45 ; however, it is normally found in water and food (Shaikhain et al, 2021). Although detection across all LMICs hospitals in this study was limited, the presence of this species with blaNDM emphasises a potential source of infection and should be monitored further.…”

Leclercia adecarboxylata infective endocarditis in a man with mitral stenosis: A case report and review of the literature

“…L. adecarboxylata is a ubiquitous microorganism, most commonly found in water and soil[ 1 , 2 ]. Cases of L. adecarboxylata infection in patients with corneal abscesses combined with keratitis have been reported with a history of exposure to the aquatic environment[ 68 ].…”

“…A few cases with diabetes as the only risk factor have L. adecarboxylata infection of the skin and soft tissues[ 81 , 82 ]. L. adecarboxylata has been implicated in endocarditis[ 6 ], catheter-associated bacteremia[ 78 ], bacteremia, sepsis[ 3 , 67 ], septic arthritis, meningitis[ 83 ], cellulitis[ 2 , 84 ], urinary tract infections[ 85 ], pneumonia[ 70 ], and bacterial peritonitis, especially in patients on peritoneal dialysis[ 86 ]. Of these, the most common clinically are catheter-associated male urinary tract infections (translocation through the genitourinary tract), followed by ventilator-associated pneumonia, peritoneal dialysis peritonitis, corneal abscesses, vascular graft infections (entry into the infected host via catheter or wound)[ 87 ], and intestinal translocation (translocation of bacteria through the mucosal barrier of the gastrointestinal tract, presumably gastrointestinal bacteremia)[ 2 , 70 ].…”

“…Leclercia adecarboxylata ( L. adecarboxylata ) is a movable Gram-negative rod-shaped bacterium in the Enterobacteriaceae family, most commonly found in water and soil[ 1 , 2 ] and rarely isolated from clinical specimens, with most of the Enterobacteriaceae characteristics, such as partly anaerobic, oxidase-negative, mesophilic, peripheral flagellate bacilli[ 3 ]. Infective endocarditis (IE) caused by L. adecarboxylata is a very rare disease in the clinic.…”