LECLERCİA ADECARBOXYLATA’YA BAĞLI GELİŞEN KATETER KAYNAKLI BAKTERİYEMİ OLGUSU

Yıl 2017, Cilt: 6 Sayı: 2, 79 - 81, 31.08.2017

Birol Şafak , Büşra Ergüt Sezer Ezgi Çoşkun Yenigün

Öz

Önceleri Enterik grup 41 veya Eschrechia adecarboxylata olarak bilinen mikroorganizma, 1962’den itibaren Leclercia adecarboxylata olarak adlandırılmıştır. Çeşitli çevresel kaynaklarda bulunan mikroorganizmanın kan, idrar, balgam, yara gibi farklı klinik örneklerden izole edildiği bildirilmiştir. Bu olgu, bilgilerimize göre ülkemizden bildirilen L. adecarboxylata’ya bağlı ilk enfeksiyon olması nedeniyle sunulmuştur.

Son dönem kronik böbrek yetmezliği olan diyalize giren 85 yaşındaki erkek hasta, ateş şikayetiyle acil servise başvurmuştur. Laboratuvar tetkiklerinde beyaz küre normal, CRP, üre ve kreatinin yüksek olarak ölçülmüştür. Yatırılarak tedavisi planlanan hastadan kateter ve perifer damar yolundan kan kültürü alınmıştır. Ampirik olarak seftriakson tedavisine başlanmıştır. Kateterden alınan kan kültürü, perifer damar yolundan alınan kan kültüründen dört saat önce olmak üzere her iki örnekten de BacT/Alert 3D (bioMerieux, Fransa) kan kültür cihazında pozitif sinyal alınmıştır. L. adecarboxylata olarak tanımlanan bakteri amikasin, gentamisin, seftazidim, seftriakson, siprofloksasin, imipenem duyarlı, amoksisilin-klavulanik asit dirençli olarak bulunmuştur. Kateterden alınan kan kültürü örneği dört saat önce pozitiflik verdiğinden kateter ilişkili L. adecarboxylata’ya bağlı bakteriyemi tanısı konulmuştur. Antibiyotik duyarlılık raporuna göre seftriakson duyarlı bulunduğundan tedavi 15 güne tamamlanmıştır.

E. coli’ye benzerliği nedeniyle sıklıkla atlanabileceğinden özellikle fosfomisin dirençli E. coli izolatlarında, ileri biyokimyasal analizlerle ayrımının yapılması gerektiği düşünülmüştür.

Anahtar Kelimeler

Leclercia adecarboxylata, kateter kaynaklı, bakteriyemi

CATHETER-RELATED BACTEREMIA CAUSED BY LECLERCIA ADECARBOXYLATA: CASE REPORT

Öz

The microorganism known as Enteric group 41 or Escherichia adecarboxylatain the past was named as Leclercia adecarboxylata since 1962. It has been reported that the microorganism, which is present in various environmental resources was isolated from different clinical specimens such as blood, urine, sputum and wound. This case report was presented, because of the fact that it is the first reported infection caused by L. adecarboxylata in our country as far as we know.

The male patient aged 85 years old on dialysis with end stage chronic renal disease was admitted to emergency service with complaint of fever. The laboratory analysis revealed high levels of CRP, urea and creatinin and normal levels of white blood cell count. Blood cultures were obtained via the catheter and peripheral vascular access, from the patient who was hospitalised to plan the treatment. Ceftriaxone was started as an empirical treatment. Both blood culture samples were positive signalling in Bact/Alert 3D (Biomeriuex, France) in which the one obtained from catheter was 4 hours earlier than the peripheral one. The bacteria identified as L. adecarboxylata was found sensitive to amikacin, gentamicin, ceftazidim, ceftriaxone, ciprofloxacin, imipenem and resistant to amoxicillin-clavulanic acid. Because of the blood culture from catheter had positive signal 4 hours prior to the one from the peripheral, the diagnosis was catheter related L.adecarboxylata bacterimia. Because the ceftriaxone was sensitive in antibiotic sensitivity report, the treatment continued 15 days. It was considered that a further biochemical analysis, especially in phosphomycine resistant E.coli isolates is needed to differentiate unnoticed isolates.

Anahtar Kelimeler

Leclercia adecarboxylata, catheter-related

Kaynakça

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