Case and Methods: A 51-year-old Filipino female with a history of hypertension, type II diabetes mellitus, and end stage renal disease on hemodialysis, presented to multiple emergency departments with persistent fever, nausea, vomiting, and abdominal pain over the course of two weeks. Blood cultures collected during one of her visits grew Leclercia adecarboxylata. She was called back to the hospital and admitted for further work-up. Computed tomography revealed possible small bowel wall thickening. Given her presenting symptoms, the GI tract was considered the most likely source of infection. The patient improved after initiation of piperacillin/tazobactam and vancomycin. Antibiotics were narrowed to ampicillin/sulbactam and azithromycin based on susceptibility testing. She was eventually discharged on cefazolin, which was continued as an outpatient to complete a two-week course of therapy. We performed a literature review for previous cases of bacteremia associated with a GI source of infection.
Results: Including this case, there have been four documented cases related to a GI source. Three of four cases involved immunocompromised patients. Isolates showed pan-sensitivity to ampicillin, piperacillin/tazobactam, second and third generation cephalosporins, gentamicin, fluoroquinolones, and carbapenems. Antibiotics with the highest sensitivity included fluoroquinolones (MIC ≤0.25 mcg/mL), followed by aminoglycosides (MIC ≤1.0 mcg/mL) and carbapenems (MIC ≤1 mcg/mL). All cases were successfully treated.
Conclusion: Leclercia adecarboxylata is rarely reported in the context of human infection, but has been isolated from multiple sources, including the GI tract. Clinicians should consider this organism in the differential diagnosis, especially in immunocompromised patients with ongoing GI symptoms.
E. Kajioka, None
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