Clinical Interpretation of Repeated Isolation of Leclercia adecarboxylata from Sputum Specimens in an Elderly Patient with Limited Systemic Inflammatory Response: A Case Report
Abstract
Background: Leclercia adecarboxylata is an uncommon Gram-negative bacillus traditionally regarded as an environmental organism or opportunistic pathogen. The clinical significance of respiratory isolation remains uncertain because sputum cultures may represent contamination, colonization, or true infection.
Case presentation: An 87-year-old man with neurological disease and abnormal pulmonary imaging developed cough, sputum production, impaired sputum clearance, and decreased oxygen saturation after prolonged immobilization. Laboratory tests showed a white blood cell count of 3.70 × 109/L and a procalcitonin level of 0.070 ng/mL, indicating a limited systemic inflammatory response. The initial sputum specimen met quality criteria and showed predominant growth of L. adecarboxylata, which was again isolated from a second specimen 2 days later. The isolate was susceptible to multiple antimicrobial agents, including ceftriaxone. Because repeated isolation did not establish pathogenicity, antimicrobial therapy was not escalated solely on the basis of culture results. Respiratory symptoms and imaging abnormalities improved after comprehensive management, but the specific contribution of L. adecarboxylata could not be confirmed.
Conclusion: Repeated isolation of uncommon bacteria from sputum specimens may provide clinically relevant information but does not independently establish infection. We propose a conceptual three-category interpretation framework comprising possible…
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