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An outbreak of Leclercia adecarboxylata from a tertiary neurocare center: A systematic approach, control and preventive measures

Background: Hospital-acquired infection (HAI) outbreaks are special-cause events having multiple factors involved in it. HAI outbreaks often reflect problems that are unique, urgent, unusual, or difficult to control. There are only a few case reports and case series of Leclercia adecarboxylata reported in the literature. Materials and Methods: The outbreak occurred in a 1000-bedded tertiary neurocare center. There was sudden isolation of an unusual organism from different samples such as tracheal secretion, ventriculo-peritoneal shunt tip, pus, wound swab, urine, and blood. All the samples were processed according to the standard protocol and antibiotic susceptibility was carried out by Kirby–Bauer disk-diffusion method and interpreted according to the Clinical and Laboratory Standards Institute guidelines. All the isolates were subjected to VITEK-2 system for confirmation. The steps involved in outbreak investigation were (1) case definition, (2) case confirmation, (3) establishing the background rate of disease and finding cases, (4) identification of source, (5) control measures, (6) communicate findings, and (7) maintain surveillance. Results: The organism was identified as L. adecarboxylata. All the isolates were resistant only to ampicillin. However, two isolates isolated from the blood of the same patient were sensitive only to imipenem and colistin. The source could not be identified with extensive efforts; however, the outbreak was controlled with strict practice of hand hygiene and other aseptic precautions. On surveillance, there was no further isolation of the organism. Conclusion: As HAI outbreaks are multifactorial, there should be preparedness for hospital infection outbreaks in all the hospitals to prevent morbidity and mortality.