LECLERCİA ADECARBOXYLATA’YA BAĞLI GELİŞEN KATETER KAYNAKLI BAKTERİYEMİ OLGUSU

Year 2017, Volume: 6 Issue: 2, 79 - 81, 31.08.2017

Birol Şafak , Büşra Ergüt Sezer Ezgi Çoşkun Yenigün

Abstract

Önceleri Enterik grup 41 veya Eschrechia adecarboxylata olarak bilinen mikroorganizma, 1962’den itibaren Leclercia adecarboxylata olarak adlandırılmıştır. Çeşitli çevresel kaynaklarda bulunan mikroorganizmanın kan, idrar, balgam, yara gibi farklı klinik örneklerden izole edildiği bildirilmiştir. Bu olgu, bilgilerimize göre ülkemizden bildirilen L. adecarboxylata’ya bağlı ilk enfeksiyon olması nedeniyle sunulmuştur.

Son dönem kronik böbrek yetmezliği olan diyalize giren 85 yaşındaki erkek hasta, ateş şikayetiyle acil servise başvurmuştur. Laboratuvar tetkiklerinde beyaz küre normal, CRP, üre ve kreatinin yüksek olarak ölçülmüştür. Yatırılarak tedavisi planlanan hastadan kateter ve perifer damar yolundan kan kültürü alınmıştır. Ampirik olarak seftriakson tedavisine başlanmıştır. Kateterden alınan kan kültürü, perifer damar yolundan alınan kan kültüründen dört saat önce olmak üzere her iki örnekten de BacT/Alert 3D (bioMerieux, Fransa) kan kültür cihazında pozitif sinyal alınmıştır. L. adecarboxylata olarak tanımlanan bakteri amikasin, gentamisin, seftazidim, seftriakson, siprofloksasin, imipenem duyarlı, amoksisilin-klavulanik asit dirençli olarak bulunmuştur. Kateterden alınan kan kültürü örneği dört saat önce pozitiflik verdiğinden kateter ilişkili L. adecarboxylata’ya bağlı bakteriyemi tanısı konulmuştur. Antibiyotik duyarlılık raporuna göre seftriakson duyarlı bulunduğundan tedavi 15 güne tamamlanmıştır.

E. coli’ye benzerliği nedeniyle sıklıkla atlanabileceğinden özellikle fosfomisin dirençli E. coli izolatlarında, ileri biyokimyasal analizlerle ayrımının yapılması gerektiği düşünülmüştür.

Keywords

Leclercia adecarboxylata, kateter kaynaklı, bakteriyemi

CATHETER-RELATED BACTEREMIA CAUSED BY LECLERCIA ADECARBOXYLATA: CASE REPORT

Abstract

The microorganism known as Enteric group 41 or Escherichia adecarboxylatain the past was named as Leclercia adecarboxylata since 1962. It has been reported that the microorganism, which is present in various environmental resources was isolated from different clinical specimens such as blood, urine, sputum and wound. This case report was presented, because of the fact that it is the first reported infection caused by L. adecarboxylata in our country as far as we know.

The male patient aged 85 years old on dialysis with end stage chronic renal disease was admitted to emergency service with complaint of fever. The laboratory analysis revealed high levels of CRP, urea and creatinin and normal levels of white blood cell count. Blood cultures were obtained via the catheter and peripheral vascular access, from the patient who was hospitalised to plan the treatment. Ceftriaxone was started as an empirical treatment. Both blood culture samples were positive signalling in Bact/Alert 3D (Biomeriuex, France) in which the one obtained from catheter was 4 hours earlier than the peripheral one. The bacteria identified as L. adecarboxylata was found sensitive to amikacin, gentamicin, ceftazidim, ceftriaxone, ciprofloxacin, imipenem and resistant to amoxicillin-clavulanic acid. Because of the blood culture from catheter had positive signal 4 hours prior to the one from the peripheral, the diagnosis was catheter related L.adecarboxylata bacterimia. Because the ceftriaxone was sensitive in antibiotic sensitivity report, the treatment continued 15 days. It was considered that a further biochemical analysis, especially in phosphomycine resistant E.coli isolates is needed to differentiate unnoticed isolates.

Keywords

Leclercia adecarboxylata, catheter-related

References

• 1. Anuradha M. Leclercia adecarboxylata isolation: case reports and review. J Clin Diagn Res. 2014; 8(12): DD03–04.
• 2. Stock I, Burak S, Wiedemann B. Natural antimicrobial susceptibility patterns and biochemical profiles of Leclercia adecarboxylata strains. Clin Microbiol Infect. 2004;10(8):724-33.
• 3. Fernández-Ruiz M, López-Medrano F, García-Sánchez L et al. Successful management of tunneled hemodialysis catheter-related bacteremia by Leclercia adecarboxylata without catheter removal: report of two cases. Int J Infect Dis. 2009;13(6):e517-8.
• 4. Hess B, Burchett A, Huntington MK. Leclercia adecarboxylata in an immunocompetent patient. J Med Microbiol. 2008;57(Pt 7):896-8.
• 5. Grantham WJ, Funk SS, Schoenecker JG. Leclercia adecarboxylata Musculoskeletal Infection in an Immune Competent Pediatric Patient: An Emerging Pathogen? Case Rep Orthop. 2015;60473.
• 6. Allawh R, Camp BJ. Isolation of Leclercia adecarboxylata from a patient with a subungual splinter. Dermatol Online J. 2015;15:21(8).
• 7. Keren Y, Keshet D, Eidelman M, Geffen Y, Raz-Pasteur A, Hussein K. Is Leclercia adecarboxylata a new and unfamiliar marine pathogen? J Clin Microbiol. 2014;52(5):1775-6.
• 8. Fattal O, Deville JG. Leclercia adecarboxylata peritonitis in a child receiving chronic peritoneal dialysis. Pediatr Nephrol. 2000;15(3-4):186-7.
• 9. Rodríguez JA, Sánchez FJ, Gutiérrez N, García JE, García-Rodríguez JA. Bacterial peritonitis due to Leclercia adecarboxylata in a patient undergoing peritoneal dialysis. Enferm Infecc Microbiol Clin. 2001;19(5):237-8.
• 10. Sethi K, Barker EM, Metlay LA, Caserta MT, Daugherty LE. Leclercia adecarboxylata Sepsis and Cerebral Herniation. J Pediatric Infect Dis Soc. 2014;3(1):e1-3.
• 11. Nelson MU, Maksimova Y, Schulz V, Bizzarro MJ, Gallagher PG. Late-onset Leclercia adecarboxylata sepsis in a premature neonate. J Perinatol. 2013;33(9):740-2.
• 12. De Mauri A, Chiarinotti D, Andreoni S, Molinari GL, Conti N, De Leo M. Leclercia adecarboxylata and catheter-related bacteraemia: review of the literature and outcome with regard to catheters and patients. J Med Microbiol. 2013;62(Pt 10):1620-3.
• 13. Shin GW, You MJ, Lee HS, Lee CS. Catheter-related bacteremia caused by multidrug-resistant Leclercia adecarboxylata in a patient with breast cancer. J Clin Microbiol. 2012;50(9):3129-32.
• 14. Prakash MR, Ravikumar R, Patra N, Indiradevi B. Hospital-acquired pneumonia due to Leclercia adecarboxylata in a neurosurgical centre.J Postgrad Med. 2015;61(2):123-5.
• 15. Haji S, Kimura H, Yamashita H. Arthritis and bacteremia due to Leclercia adecarboxylata. Intern Med. 2014;53(22):2659.
• 16. Sawamura H, Kawamura Y, Yasuda M et al. A clinical isolate of Leclercia adecarboxylata from a patient of Pyelonephritis.Kansenshogaku Zasshi. 2005;79(10):831-5.
• 17. Bali R, Sharma P, Gupta K, Nagrath S. Pharyngeal and peritonsillar abscess due to Leclercia adecarboxylata in an immunocompetant patient.J Infect Dev Ctries. 2013;7(1):46-50.
• 18. Lee B, Sir JJ, Park SW et al. A case of Leclercia adecarboxylata endocarditis in a woman with endometrial Cancer.Am J Med Sci. 2009;337(2):146-7.
• 19. Voulalas G, Makris S, Papacharalampous G, Maltezos C. Mycotic Aneurysm Due to Leclercia Adecarboxylata: A Complication of Vertebral Osteomyelitis. Ann Vasc Surg. 2016;33:e1-5.
• 20. Jill P Stone , Hannah St Denis-Katz , Claire Temple-Oberle, Phillipe Mercier, Jonah B Mizzau, Alim P Mitha. Leclercia adecarboxylata: The First Reported Infection of Cerebrospinal Fluid and a Systematic Review of the Literature. J Neuroinfect Dis 2014,6:3.