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Kidney Week

Abstract: TH-PO898

A Case of Leclercia Adecarboxylata Hemodialysis Catheter-Related Bacteremia

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Alfi, Yasir, George Washington University, Washington, District of Columbia, United States
  • Collins, Ashte K., George Washington University, Washington, District of Columbia, United States
Background

Leclercia adecarboxylata, formerly known as Escherichia adecarboxylata, was first identified by Lecrerc in 1962. It is a motile Gram-negative rod that is considered an uncommon opportunistic human pathogen. Here we describe a case of L. adecarboxylata bacteremia as part of a polymicrobial infection in a dialysis patient with a tunneled catheter.

Methods

A 50 year-old male with ESRD on HD for 7 months via left internal jugular tunneled catheter, HTN, and DM type II, who was admitted to the hospital with 1 day of subjective fever, chills, and malaise, all of which exacerbated by his dialysis treatment. He reported taking showers while the dialysis catheter is in place, but stated he only lets the water land below his chest. On admission, he was afebrile and hemodynamically stable. Lab results were remarkable for WBC of 19.6 x 103/µl. Vancomycin and piperacillin-tazobactam were started. Blood cultures grew Staphylococcus epidermidis (oxacillin-resistant), methicillin-sensitive Staphylococcus aureus, Pseudomonas floures (resistant to trimethoprim-sulfamethoxazole), Escherichia coli (pansensitive), Serratia marcescens (resistant to ampicillin and first generation cephalosporins) and Leclercia adecarboxylata (pan-sensitive). Antibiotic regimen was changed to vancomycin, gentamicin and levofloxacin. The tunneled catheter was removed and a new right internal jugular tunneled catheter was placed 4 days later, after clearance of blood cultures. He was maintained on the above antibiotics for another 14 days, and recovered without long-term sequelae.

Conclusion

L. adecarboxylata is a ubiquitous organism and has been isolated from water sources including drinking water in the US. Water exposure is a possible source of infection in the patient presented above. Although there are several case reports of clinically significant infections with L. adecarboxylata in immunocompromised patients, it has been mostly isolated from post-traumatic flora in immunocompetent individuals. ESRD patients may be susceptible to L. adecarboxylata infection as they are relatively immunosuppressed. Only four previous reports were found on a PubMed literature search of tunneled hemodialysis catheter-related bacteremia with L. adecarboxylata. This infection can be treated successfully with catheter removal and a course of appropriate IV antibiotics. Most isolates are susceptible to all available antimicrobial agents.