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Dotis J, Kondou A, Karava V, Sotiriou G, Papadopoulou A, Zarras C, Michailidou C, Vagdatli E, Printza N. Leclercia adecarboxylata in Peritoneal Dialysis Patients: A Systematic Review. Pediatr Rep 2023; 15:293-300. [PMID: 37218925 DOI: 10.3390/pediatric15020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/24/2023] Open
Abstract
Background:Leclercia adecarboxylata is a Gram-negative bacillus that can rarely cause infections in humans. We recently treated a case of peritonitis due to L. adecarboxylata in a peritoneal dialysis (PD) pediatric patient, and we systematically reviewed all the relevant reported cases in the literature. Methods: We searched the PubMed and Scopus databases, and we reviewed 13 such cases (2 children, 11 adults) that were reported, including our patient. Results: The mean (±SE) age was 53.2 ± 22.5 years, with a male-to-female ratio of approximately 1:1.6. Their mean vintage period on PD prior to L. adecarboxylata peritonitis was 37.5 ± 25.3 months. The VITEK card was the identification diagnostic tool in most cases (63%). The antimicrobial agent that was most frequently used was ceftazidime, which was implemented in 50% of cases as initial therapy, either as a monotherapy or combination therapy; in only two patients (15.3%) was the Tenkhoff catheter removed. The median duration of treatment was 18 days (range of 10-21 days), and all 13 patients that were reviewed were healed. Conclusions: Physicians should be aware that L. adecarboxylata is noted to rarely cause peritonitis in PD patients; however, this pathogen seems to be sensitive to most antimicrobial agents and can result in a favorable outcome with the selection of appropriate treatment.
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Affiliation(s)
- John Dotis
- First Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Antonia Kondou
- First Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Vasiliki Karava
- First Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Georgia Sotiriou
- First Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Athina Papadopoulou
- First Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Charalampos Zarras
- Department of Microbiology, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Chrysi Michailidou
- Department of Microbiology, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Eleni Vagdatli
- Department of Microbiology, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
| | - Nikoleta Printza
- First Department of Pediatrics, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642 Thessaloniki, Greece
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Genomic insights of Leclercia adecarboxylata strains linked to an outbreak in public hospitals in Mexico. Genes Genomics 2023; 45:569-579. [PMID: 36635459 DOI: 10.1007/s13258-022-01348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Leclercia adecarboxylata is a bacteria closely related to Escherichia coli according to its biochemical characteristics and is commonly considered non-pathogenic although a growing number of publications classify it as an emerging pathogen. Fosfomycin resistance is a common trait for L. adecarboxylata encoded by fosALA gene. OBJECTIVE To analyze genomic traits of sixteen L. adecarboxylata strains isolated from blood culture and a bottle of total parenteral nutrition. METHODS Twenty-eight L. adecarboxylata strains isolated from blood culture and a bottle of total parenteral nutrition were identified biochemically with a Vitek ® automated system. The strains were phenotyped by their growth on Eosin Methylene Blue agar or MacConkey agar plates. Additionally, Pulsed field gel electrophoresis (PFGE) was performed to establish the clonal relationship. The genomic DNA of sixteen strains was obtained using a Qubit ® dsDNA HS Assay Kit and sequenced on an Illumina ® MiSeq instrument. Draft genomes were assembled using PROKKA and Rast. Assemblies were submitted to Resfinder and PathogenFinder from the Center for Genomic Epidemiology in order to find resistance genes and pathogenic potential. IslandViewer4 was also used to find Pathogenicity and Phage Islands. For identification of the fosA gene, manual curation and Clustal analysis was performed. A novel FosA variant was identified. Finally, phylogenetic analysis was performed using VAMPhyRE software and Mega X. RESULTS In this paper, we report the genomes of sixteen strains of Leclercia adecarboxylata causing an outbreak associated with parenteral nutrition in public hospitals in Mexico. The genomes were analyzed for genetic determinants of virulence and resistance. A high pathogenic potential (pathogenicity index 0.82) as well as multiple resistance genes including carbapenemics, colistin and efflux pumps were determined. Based on sequence analysis, a new variant of the fosALA gene was described. Finally, the outbreak was confirmed by establishing the clonal relationship among the sixteen genomes obtained. CONCLUSIONS Commensal strains of L. adecarboxylata may acquire genetic determinants that provide mechanisms of host damage and go unnoticed in clinical diagnosis. L. adecarboxylata can evolve in a variety of ways including the acquisition of resistance and virulence genes representing a therapeutic challenge in patient care.
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Adapa S, Konala VM, Nawaz F, Javed T, Dhingra H, Gutierrez IA, Ramirez ML. Peritonitis from Leclercia adecarboxylata: An emerging pathogen. Clin Case Rep 2019; 7:829-831. [PMID: 30997095 PMCID: PMC6452466 DOI: 10.1002/ccr3.2094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/02/2019] [Accepted: 02/20/2019] [Indexed: 01/22/2023] Open
Abstract
Leclercia adecarboxylata can be misidentified as Escherichia coli, due to similar biochemical properties. Automated identification systems and mass spectrometry play a very critical role in isolating atypical organisms like L adecarboxylata. General guidelines recommend treating L adecarboxylata peritonitis for 3 weeks without removal of peritoneal dialysis catheter.
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Affiliation(s)
- Sreedhar Adapa
- Division of NephrologyThe Nephrology GroupFresnoCalifornia
| | - Venu Madhav Konala
- Divison of Medical Oncology, Department of Internal MedicineAshland Bellefonte Cancer CenterAshlandKentucky
| | - Faiza Nawaz
- Department of Family MedicineKaweah Delta Medical CenterVisaliaCalifornia
| | - Tariq Javed
- Division of NephrologyKaweah Delta Medical CenterVisaliaCalifornia
| | - Hemant Dhingra
- Division of NephrologyThe Nephrology GroupFresnoCalifornia
| | - Irene A. Gutierrez
- Department of Family MedicineKaweah Delta Medical CenterVisaliaCalifornia
| | - Magda L. Ramirez
- Department of Family MedicineKaweah Delta Medical CenterVisaliaCalifornia
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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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