Case Report	A Rare Agent in Wound Infection: Leclercia adecarboxylata Yara Yeri Enfeksiyonunda Nadir Bir Etken: Leclercia adecarboxylata Ayşe KORKMAZ AKYÜZ^1[ID] Abstract As a rare infectious agent, Leclercia adecarboxylata is a gram-negative bacillus belonging to the Enterobacteriaceae family. It can be isolated from human blood, sterile body fluids, sputum, urine, fecal, and wound samples. In this case report, the isolation of L. adecarboxylata as a causative agent in the wound and tissue sample cultures of a soft tissue infection that developed after arthrodesis surgery on the right foot of a 47-year-old female patient who was followed up with Charcot foot treatment due to diabetes in our hospital is presented. The patient's general condition was good, his leukocyte count was 6000/ml, leukocyte distribution was 58% neutrophil predominance, erythrocyte sedimentation rate was 105 mm/hour, and C-reactive protein level was 90 mg/L. Wound and tissue samples from the area considered to be the focus of infection were sent to our laboratory for culture examination. In the samples inoculated into routine identification media and subjected to standard incubation and identification procedures, a growth consisting of pure colonies (monomicrobial) was detected on the culture media. The isolate was identified as L. adecarboxylata by colony morphology, microscopic examinations (gram-negative bacilli), other basic identification procedures, and mass spectrometry (MALDI-TOF MS). Since it is a rare infectious agent, additional biochemical tests were performed; glucose-sucrose-lactose utilization, motility, indole production, and esculin hydrolysis tests were found to be positive, while oxidase, ornithine decarboxylase, hydrogen-sulfide production, citrate utilization, and urease tests were found to be negative. Antibiotic susceptibility tests were performed with the VITEK 2® automated system (Biomérieux, France), and the results were evaluated according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) v13.0 criteria. The isolate, which has a generally sensitive antibiotic profile, was evaluated as the infectious agent and the patient was treated with intravenous ampicillin/sulbactam for five days. The patient, whose laboratory values tended to improve (leukocyte count 4400/ml, neutrophil rate 52.9%), was discharged with peroral amoxicillin/clavulanic acid treatment. Keywords: Leclercia adecarboxylata, Charcot foot, Wound infection, Diabetes. Özet Nadir bir enfeksiyon etkeni olarak Leclercia adecarboxylata, Enterobacteriaceae familyasına ait gram negatif bir basildir. İnsanların kan, steril vücut sıvıları, balgam, idrar, fekal ve yara örneklerinden izole edilebilmektedir. Bu olgu sunumunda, hastanemizde diyabete bağlı Charcot ayağı tedavisi ile takip edilen 47 yaşında kadın hastanın, sağ ayağında artrodez ameliyatı sonrası gelişen yumuşak doku enfeksiyonunda yara ve doku örneği kültürlerinde etken olarak L. adecarboxylata’nın izolasyonu sunulmuştur. Genel durumu iyi olan hastanın lökosit sayısı 6000/ml, lökosit dağılımı %58 nötrofil hakimiyeti, eritrosit sedimentasyon hızı 105 mm/saat ve C-reaktif protein düzeyi 90 mg/L olarak saptandı. Enfeksiyon odağı olarak değerlendirilen bölgeden alınan yara ve doku örneği kültür incelemesi için laboratuvarımıza gönderildi. Rutin tanımlama besiyerlerine inoküle edilerek standart inkübasyon ve tanımlama prosedürleri uygulanan örneklerde besiyerinde saf kolonilerden oluşan (monomikrobiyal) üreme saptandı. Koloni morfolojisi, mikroskobik incelemeler (gram negatif basil), temel identifikasyon prosedürleri ve kütle spektrometresi (MALDI-TOF MS) ile L. adecarboxylata olarak tanımlanan izolat nadir bir enfeksiyon etkeni olduğundan ek biyokimyasal testler yapıldı ve glikoz-sukroz-laktoz kullanımı, motilite, indol üretimi ve eskülin hidrolizi testleri pozitif olarak saptanırken, oksidaz, ornitin dekarboksilaz, hidrojen sülfür üretimi, sitrat kullanımı ve üreaz testleri negatif olarak belirlendi. VITEK 2^® otomatize sistemi (Biomérieux, Fransa) ile antibiyotik duyarlılık testleri yapıldı ve sonuçlar EUCAST (European Committee on Antimicrobial Susceptibility Testing) v13.0 kriterlerine göre değerlendirildi. Genel olarak duyarlı bir antibiyotik profili olduğu belirlenen izolat enfeksiyon etkeni olarak değerlendirildi ve hastaya beş gün süre ile intravenöz ampisilin/sulbaktam tedavisi uygulandı. Laboratuvar değerleri iyileşme eğiliminde (lökosit sayısı 4400/ml, nötrofil oranı %52.9) olan hasta peroral amoksisilin/klavulanik asit tedavisi ile taburcu edildi. Anahtar kelimeler: Leclercia adecarboxylata, Charcot ayağı, Yara enfeksiyonu, Diyabet. Figure 1. Colony morphology of the Leclercia adecarboxylata isolate passage on different media (5% sheep blood agar, Eosin-Methylene blue agar, and chocolate agar) (left). Microscopic view (×100 magnification) of the Gram-stained preparation (right). Figure 1 png Figure 2. Leclercia adecarboxylata isolate on esculin, triple sugar iron, urea, Simon's citrate, and motility indole ornithine agars. Glucose-sucrose-lactose utilization, motility, indole production, and esculin hydrolysis were positive, while ornithine decarboxylase, hydrogen-sulfide production, citrate utilization, and urease were negative. Figure 2 png Figure 3. A total of 144 Leclercia adecarboxylata infection sites in 135 different patients including the present case, from 1991 to 2023. Data were collected from other reviews and the current case reports excluding repeated cases [2,3,5-7,11-13,16-41] (mainly published in the PubMed database). Soft tissue infections: Skin, abscess, folliculitis, cellulite, wound, postoperative incision site, necrotizing fasciitis. Bacteremia: Sepsis, catheter-related bacteremia, with and without any infection site. Data from two epidemics (in 2021 and in 2023) related to total parenteral nutrition reported from Mexico were not added to this graphic due to the different transmission routes and infection patterns [14,15]. Figure 3 png
DOI: 10.54584/lms.2024.47
Article in English
^1Department of Medical Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye.
*Corresponding author Ayşe Korkmaz Akyüz; MD., Department of Medical Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Türkiye. E-mail: draysekorkmazakyuz@gmail.com
Received: 30.12.2023 Accepted: 11.01.2024 Published: 18.01.2024
Cite as: Korkmaz Akyüz A. A Rare Agent in Wound Infection: Leclercia adecarboxylata. Life Med Sci 2024; 3(1): 16-21.
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