Leclercia adecarboxylata-Associated Catheter-Related Bloodstream Infection in a Hemodialysis Patient: A Case Report and Literature Review.

Leclercia adecarboxylata (L. adecarboxylata) is a motile, gram-negative bacillus from the Enterobacteriaceae family, traditionally considered a low-virulence environmental organism and gut commensal. However, increasing reports have pointed to its emerging role as an opportunistic pathogen capable of causing clinically significant infections in both immunocompromised and immunocompetent individuals. We describe a case of catheter-related bloodstream infection (CRBSI) in a 49-year-old female with end-stage renal disease on maintenance hemodialysis via a tunneled central venous catheter. She presented with persistent fever, myalgia, and elevated inflammatory markers. Paired blood cultures from the catheter and peripheral vein flagged positive within 24 hours, with earlier positivity in the catheter sample, suggesting CRBSI. Pure growth of gram-negative bacilli was identified as L. adecarboxylata using VITEK®2 and later re-confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Antimicrobial susceptibility testing demonstrated broad susceptibility except to select cephalosporins. The patient was successfully treated with intravenous meropenem and gentamicin lock therapy, resulting in complete clinical resolution. This case highlights the emerging clinical importance of L. adecarboxylata as a cause of CRBSI in hemodialysis patients. Accurate identification and prompt, targeted treatment are crucial for the best outcomes. It also underscores the organism's ability to colonize devices and the need for increased clinical vigilance. Given the rise in reports of antimicrobial resistance, continuous surveillance and further research are necessary to better understand its pathogenic potential and to develop optimal management strategies.