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Bronte Anaut M, Arredondo Montero J, García Abellás P, de Uribe Viloria M, Regojo Zapata RM. Fulminant Sepsis Caused by Leclercia adecarboxylata in a Premature Neonate: Case Report and Review of the Literature. Pediatr Infect Dis J 2022; 41:e220-e222. [PMID: 35135996 DOI: 10.1097/inf.0000000000003472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hospital-acquired infections are especially evident in premature infants because of prolonged stays and the need for invasive procedures. Leclercia adecarboxylata is an uncommon emerging Gram-negative bacterium that has been described in catheter and noncatheter-related infections, immunocompromised patients and less frequently affecting healthy subjects. We report a case with a postmortem diagnosis of a 24-week-old premature neonate who died as a complication of nosocomial sepsis related to an infection by L. adecarboxylata. Although the cases of L. adecarboxylata infection in children have been rarely reported, this case appears to be the first in which an infection by L. adecarboxylata is accompanied by focal spontaneous ileal perforation.
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Hassan I, Gupta P, Ray P, Tiewsoh K. Leclercia adecarboxylata Causing Spontaneous Bacterial Peritonitis in a Child with Nephrotic Syndrome: A Case Report and Review of Literature. J Lab Physicians 2020; 12:222-224. [PMID: 33268941 PMCID: PMC7684983 DOI: 10.1055/s-0040-1721162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Infection is an important complication of childhood nephrotic syndrome (NS) and spontaneous bacterial peritonitis (SBP) is a frequently encountered one. We present a 7-year-old boy with NS who had decreased urine output, generalized body swelling, and abdominal pain. Urine analysis showed proteinuria of 50 mg/m
2
/d. Ascitic tap showed total leukocyte count of 100 cells/mm
3
, sugar of 67 mg/dL, and protein of 1.1 g/dL. Gram stain revealed gram-negative bacilli with pus cells and culture grown
Leclercia adecarboxylata
(LAD). LAD was identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) with an identification score of 2.0. The organism showed good susceptibility to common antibiotics. The boy had no direct contact with livestock and the source of infection remains speculative. Devitalized skin because of massive edema seems to be the most plausible site of entry for the organism. Our patient was started on ceftriaxone and improved. LAD is a rare opportunistic pathogen, which belongs to
Enterobacteriaceae
and usually causes soft tissue infections. As far as we know, this is the first case where it has caused peritonitis in a child with NS. We also reviewed other pediatric cases.
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Affiliation(s)
- Ijas Hassan
- Division of Pediatric Nephrology, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Parakriti Gupta
- Department of Microbiology, Research Block-A, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallab Ray
- Department of Microbiology, Research Block-A, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karalanglin Tiewsoh
- Division of Pediatric Nephrology, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Keyes J, Johnson EP, Epelman M, Cadilla A, Ali S. Leclercia adecarboxylata: An Emerging Pathogen Among Pediatric Infections. Cureus 2020; 12:e8049. [PMID: 32537268 PMCID: PMC7286590 DOI: 10.7759/cureus.8049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Leclercia adecarboxylata is a gram-negative bacillus of the Enterobacteriaceae family. It is a rare human pathogen that is often acquired via wound and/or contact with aquatic environment. Although multiple cases of L. adecarboxylata infections are described in the adult population, few have been documented in pediatrics. We will present two cases of L. adecarboxylata infections in the pediatric population. The first is a case of cellulitis in an 11-year-old male patient after a penetrating wound. The second is a first-documented urinary tract infection in a 16-year-old male patient with chronic kidney disease. Both patients were successfully treated with antibiotics and surgical intervention, if necessary. These cases highlight the growing emergence of this bacterium in the pediatric population and the need to become more aware of its threat even in patients who are immunocompetent.
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Affiliation(s)
- Jonathan Keyes
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Evan P Johnson
- Orthopaedics, University of Central Florida College of Medicine, Orlando, USA
| | - Monica Epelman
- Radiology, Nemours Children's Hospital/University of Central Florida College of Medicine, Orlando, USA
| | - Adriana Cadilla
- Infectious Disease, Nemours Children's Hospital, Orlando, USA
| | - Syed Ali
- Inpatient Pediatrics, Nemours Children's Hospital, Orlando, USA
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Spiegelhauer MR, Andersen PF, Frandsen TH, Nordestgaard RLM, Andersen LP. Leclercia adecarboxylata: a case report and literature review of 74 cases demonstrating its pathogenicity in immunocompromised patients. Infect Dis (Lond) 2018; 51:179-188. [PMID: 30488747 DOI: 10.1080/23744235.2018.1536830] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Leclercia adecarboxylata is a Gram-negative bacterium belonging to the family Enterobacteriaceae. It has been described as an emerging human pathogen with the potential to cause severe infection in immunocompromised patients. The aim of this study was to describe a clinical case of infection with L. adecarboxylata and give a review of previous reports on infection. We report the presence of L. adecarboxylata in a patient initially admitted to our hospital for a lung transplant. She had diarrhoea, urinary tract infection and pneumonia caused by L. adecarboxylata. The isolate was resistant to trimethoprim-sulfamethoxazole and susceptible to 15 other antibiotics tested. The literature search for previous reports of infection with L. adecarboxylata resulted in 61 publications describing 74 cases. Bacteremia and wound infections were most often described, and only a few cases were fatal. L. adecarboxylata was most often found as a monomicrobial infection in immunocompromised patients, and as part of a polymicrobial infection in immunocompetent patients. The previously described isolates showed a high susceptibility to antibiotics, and treatment was efficient in most cases. Due to similarities in metabolic products, L. adecarboxylata might have been mistaken as Escherichia spp., but with new identification methods such as MALDI-TOF MS, it is possible to obtain a certain identification.
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Affiliation(s)
- Malene Roed Spiegelhauer
- a Department of Clinical Microbiology , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Peter Fruergaard Andersen
- b Department of Cardiothoracic Surgery , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Tove Havnhøj Frandsen
- a Department of Clinical Microbiology , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | | | - Leif Percival Andersen
- a Department of Clinical Microbiology , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
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Sass L, Karlowicz MG. Healthcare-Associated Infections in the Neonate. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152335 DOI: 10.1016/b978-0-323-40181-4.00094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Abstract
Bacteremia and sepsis are conditions associated with high mortality and are of great impact to health care operations. Among the top causes of mortality in the United States, these conditions cause over 600 fatalities each day. Empiric, broad-spectrum treatment is a common but often a costly approach that may fail to effectively target the correct microbe, may inadvertently harm patients via antimicrobial toxicity or downstream antimicrobial resistance. To meet the diagnostic challenges of bacteremia and sepsis, laboratories must understand the complexity of diagnosing and treating septic patients, in order to focus on creating algorithms that can help direct a more targeted approach to antimicrobial therapy and synergize with existing clinical practices defined in new Surviving Sepsis Guidelines. Significant advances have been made in improving blood culture media; as yet no molecular or antigen-based method has proven superior for the detection of bacteremia in terms of limit of detection. Several methods for rapid molecular identification of pathogens from blood cultures bottles are available and many more are on the diagnostic horizon. Ultimately, early intervention by molecular detection of bacteria and fungi directly from whole blood could provide the most patient benefit and contribute to tailored antibiotic coverage of the patient early on in the course of the disease. Although blood cultures remain as the best means of diagnosing bacteremia and candidemia, complementary testing with antigen tests, microbiologic investigations from other body sites, and histopathology can often aid in the diagnosis of disseminated disease, and application of emerging nucleic acid test methods and other new technology may greatly impact our ability to bacteremic and septic patients, particularly those who are immunocompromised.
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Leclercia adecarboxylata Musculoskeletal Infection in an Immune Competent Pediatric Patient: An Emerging Pathogen? Case Rep Orthop 2015; 2015:160473. [PMID: 26609458 PMCID: PMC4644830 DOI: 10.1155/2015/160473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/28/2015] [Indexed: 12/04/2022] Open
Abstract
Case. An immune competent pediatric patient presented with a persistent lower extremity infection with Leclercia adecarboxylata after a penetrating injury. This case report details the presentation, clinical course, and treatment. Conclusion. Leclercia adecarboxylata has increasing reports in immunosuppressed and adult patients with musculoskeletal infection. This case now indicates that Leclercia adecarboxylata is a potential pathogen in immune competent children in musculoskeletal tissue.
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García-Fulgueiras V, Seija V, Aguerrebere P, Cordeiro NF, Vignoli R. First report of a clinical isolate of Leclercia adecarboxylata harbouring multiple resistance genes in Uruguay and review of the literature. J Glob Antimicrob Resist 2014; 2:77-81. [DOI: 10.1016/j.jgar.2014.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/27/2013] [Accepted: 01/02/2014] [Indexed: 11/16/2022] Open
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Sethi K, Barker EM, Metlay LA, Caserta MT, Daugherty LE. Leclercia adecarboxylata Sepsis and Cerebral Herniation. J Pediatric Infect Dis Soc 2014; 3:e1-3. [PMID: 26624912 DOI: 10.1093/jpids/pis131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 09/13/2012] [Indexed: 01/04/2023]
Abstract
Leclercia adecarboxylata, a gram-negative bacillus of the Enterobacteriaceae family, is rarely identified as a pathogen in humans. We describe a fatal case of L adecarboxylata sepsis in a child. This is the first reported pediatric death associated with infection due to L adecarboxylata.
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Affiliation(s)
| | - Eric M Barker
- Department of Pathology, University of Rochester School of Medicine and Dentistry, New York
| | - Leon A Metlay
- Department of Pathology, University of Rochester School of Medicine and Dentistry, New York
| | - Mary T Caserta
- Division of Infectious Diseases, Department of Pediatrics
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Nelson MU, Maksimova Y, Schulz V, Bizzarro MJ, Gallagher PG. Late-onset Leclercia adecarboxylata sepsis in a premature neonate. J Perinatol 2013; 33:740-2. [PMID: 23986093 DOI: 10.1038/jp.2013.34] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 02/15/2013] [Indexed: 12/22/2022]
Abstract
The epidemiology, etiology and outcome of neonatal sepsis are changing over time. While monitoring longitudinal trends in neonatal sepsis in our institution, we encountered a case of late-onset neonatal sepsis due to Leclercia adecarboxylata. A Gram-negative rod previously not encountered in the clinical setting, L. adecarboxylata has recently emerged as a human pathogen, primarily in immunosuppressed patients. This report describes the clinical and laboratory features of this case of late-onset L. adecarboxylata sepsis, and reviews significant features of infection associated with this emerging pathogen.
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Affiliation(s)
- M U Nelson
- Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520, USA
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Catheter-related bacteremia caused by multidrug-resistant Leclercia adecarboxylata in a patient with breast cancer. J Clin Microbiol 2012; 50:3129-32. [PMID: 22760051 DOI: 10.1128/jcm.00948-12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a multidrug-resistant strain of Leclercia adecarboxylata responsible for catheter-related bacteremia in a 47-year-old female with breast cancer. The isolated strain was resistant to several β-lactams, aminoglycosides, and folate pathway inhibitors and harbored bla(TEM-1) and bla(CTX-M) group 1 and intl1 genes (dfrA12-orfF-aadA2) as genetic determinants for resistance. Based on a review of the L. adecarboxylata literature, there have been only 4 reports of antibiotic-resistant strains. To our knowledge, this is the first report of an L. adecarboxylata strain with simultaneous resistance to β-lactams, aminoglycosides, and sulfonamides.
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