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

Abstract

RESUMENLeclercia adecarboxylata y Raoultella ornithinolytica constituyen bacterias Gram-negativas emergentes. Los casos descritos son excepcionales. En los últimos años, las mejoras en las técnicas de diagnóstico microbiológico han permitido su detección y conocimiento. Se presenta el caso de un niño de 11 años con enfermedad mitocondrial, portador de catéter venoso central de larga duración, que desarrolló dos episodios de sepsis por L. adecarboxylata y R. ornithinolytica, respectivamente. En los casos de infección asociada al uso de catéter, es posible, en ocasiones, el tratamiento sin su retirada con evolución favorable. Es importante reconocer L. adecarboxylata y R. ornithinolytica como patógenos de diagnóstico cada vez más frecuentes, sobre todo, en pacientes inmunodeprimidos o con patologías crónicas asociadas. Palabras clave: sepsis, Enterobacteriaceae, infecciones relacionadas con catéteres, enfermedades mitocondriales, pediatría.ABSTRACT Leclercia adecarboxylata and Raoultella ornithinolytica are emergent Gram-negative bacteria. Infections caused by these microorganisms are exceptional. Improvement of microbiologist techniques in the last years has enabled their detection and more accurate knowledge. We present the case of an 11-year-old boy with mitochondrial disease with a longterm central catheter who suffered from two sepsis caused by L. adecarboxylata and R. ornithinolytica, respectively. In catheter-related infections, sometimes it is possible to provide antimicrobial treatment without removal of catheter with good results, as in our patient. It is important to recognize L. adecarboxylata and R. ornithinolytica like increasingly frequent pathogenic bacteria, mostly in immunocompromised or chronic patients.

Emergence of NDM-1- and CTX-M-3-Producing Raoultella ornithinolytica in Human Gut Microbiota

“…Intermittent but lethal nosocomial infections by R. ornithinolytica have been increasingly reported in the past decade (De Petris and Ruffini, 2018), and the advent of techniques like MALDI-TOF MS has enabled identification of new isolates (De Jong et al, 2013; Seng et al, 2016). Notable reports of R. ornithinolytica infections include sepsis in a patient with mitochondrial disease in Spain (Sanchez-Codez et al, 2019), urinary tract infection in a pediatric patient in Turkey (Buyukcam et al, 2019), and ventilator associated pneumonia in two immunocompetent trauma patients in USA (Van Cleve et al, 2018). R. ornithinolytica has also been implicated in joint infections and appendicitis in the clinical setting (Beye et al, 2018; Hajjar et al, 2018).…”

Leclercia adecarboxylata invasive infection in a patient with Hirschsprung disease: A case report

“…In addition, variety of diseases caused by L. adecarboxylata are bacteremia, sepsis, septic arthritis, diarrhea, peritonitis, gallbladder infections and meningitis. It is a common pathogen in many opportunistic Enterobacteriaceae species [ [11] , [12] , [13] , [14] , [15] , [16] ].…”

“…Knowledge of the route of transmission of L. adecarboxylata is limited and the possible source of the infection is unclear. However, the authors describe three hypotheses of contamination of our propositus: (i) bacterial translocation across the mucosal barrier of the gastrointestinal tract, (ii) catheters or wounds entry to infect host and (iii) translocation through genitourinary tract [ 1 , 2 , 4 , 12 , 15 ]. In our patient, one or more of these routes of contamination would be possible.…”