Leclercia adecarboxylataBacteremia in a Patient with Ulcerative Colitis

Abstract

Patients with inflammatory bowel disease (IBD) are a high risk population for bacteremia. Derangement in the mucosal architecture of the gastrointestinal (GI) tract and frequent endoscopic interventions in immunocompromised individuals are considered primary causes. Isolation of opportunistic microorganisms from the bloodstream of IBD patients has been increasingly reported in recent years. Leclercia adecarboxylata is a ubiquitous, aerobic, motile, gram-negative bacillus. The human GI tract is known to harbor this rarely pathogenic microorganism. There are only a few case reports of bacteremia with this microorganism; the majority are either polymicrobial or associated with immunocompromised patients. We describe a case of monomicrobial L. adecarboxylata bacteremia in a 43-year-old female who presented with bloody diarrhea. Colonoscopy revealed diffuse colonic mucosal inflammation with numerous ulcers, and histopathology revealed crypt abscesses. Following an episode of rectal bleeding, two sets of blood cultures grew L. adecarboxylata, which was treated with intravenous ceftriaxone. After a complicated hospital course, she was eventually diagnosed with ulcerative colitis and enteropathic arthritis, treated with intravenous methylprednisolone, mesalamine, and infliximab which resulted in resolution of her symptoms. In our previously immunocompetent patient, derangement of the gut mucosal barrier was the likely cause of bacteremia, yet performing endoscopic intervention may have contributed to bacterial translocation.

A rarely isolated Gram-negative bacterium in microbiology laboratories: Leclercia adecarboxylata

“…Both identification systems accurately identified L. adecarboxylata isolates. In literature, there are many reports that L. adecarboxylata was identified by automated identification systems and mass spectrometry [4,[6][7][8][9][10]. However, only two of these reports were confirmed by 16S rRNA gene sequencing, like our report [9,10].…”

“…They also stated that fosfomycin resistance might be useful to differentiate L. adecarboxylata and E. coli [2]. Despite this knowledge, there were no information about fosfomycin resistance, or it was not tested in most of the studies [2][3][4][6][7][8][9][10]. One of our isolates was resistant to fosfomycin, whereas the other was susceptible.…”

Fatal Clostridium perfringens Septicemia After Colonoscopic Polypectomy, Without Bowel Perforation

“…With regard to the last hypothesis, it is interesting to note that 2.2% of all patients undergoing colonoscopy displays uncomplicated bacteremia and patients with IBD are a high‐risk population for bacteremia , showing a possible mechanism for bacteria to overstep the bowel wall.…”

Infección asociada a catéter por Leclercia adecarboxylata y Raoultella ornithinolytica en un paciente con enfermedad mitocondrial

“…Igualmente, se han expuesto bacteriemias en pacientes con patología digestiva, como úlcera péptica, 11 colecistitis y colitis ulcerosa, debido a alteraciones de la flora saprófita y aumento de permeabilidad gastrointestinal. 3 Se han descrito bacteriemias asociadas al uso de catéter, sobre todo, de diálisis peritoneal. Más infrecuentes son las relacionadas con el catéter vascular (especialmente, centrales, permanentes y tunelizados) para NP, como nuestro caso, o quimioterapia.…”

“…1 Es ubicuo en la naturaleza; está presente en las aguas, en los líquidos orgánicos y en el tracto gastrointestinal tanto humano como animal. 2,3 Se ha descrito como agente productor de bacteriemia, peritonitis, 4 infecciones de piel y tejidos blandos (IPTB), 4 neumonía, endocarditis, 2 absceso periamigdalino 5 y colecistitis, entre otros.…”