A Rare Agent in Wound Infection: Leclercia adecarboxylata

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.