First report of a clinical isolate of Leclercia adecarboxylata harbouring multiple resistance genes in Uruguay and review of the literature Virginia Garcı ´a-Fulgueiras a , Vero ´ nica Seija b , Paula Aguerrebere a , Nicola ´s F. Cordeiro a , Rafael Vignoli a, * a Departamento de Bacteriologı´a y Virologı´a, Instituto de Higiene, Facultad de Medicina, Universidad de la Repu ´blica, Montevideo, Uruguay b Seccio ´n Bacteriologı´a, Laboratorio Central, Hospital Pasteur, Administracio ´n de los Servicios de Salud del Estado, Larravide S/N, Montevideo, Uruguay 1. Introduction Leclercia adecarboxylata is a member of the Enterobacteriaceae family and is considered an opportunistic pathogen, usually involved in polymicrobial infections in immunocompromised patients [1]. However, there are a few reports of monomicrobial infections caused by this micro-organism in immunocompetent patients (e.g. wound infection and pharyngeal abscess) [2,3]. In general, L. adecarboxylata strains have remained susceptible to antibiotics such as tetracyclines, aminoglycosides, b-lactams, quinolones, trimethoprim/sulfamethoxazole (SXT) and chloram- phenicol [4]. However, in recent years there has been an increase in the number of isolates harbouring different mechanisms of antibiotic resistance [1,5,6]. Here we report a case of osteomyelitis due to a L. adecarboxylata isolate carrying plasmid-encoded resistance genes to b-lactams (oxyimino-cephalosporins, cephamycins and amoxicillin/clavula- nic acid), aminoglycosides, quinolones, chloramphenicol, sulpho- namides and rifampicin. 2. Materials and methods 2.1. Patient In June 2012, a 59-year-old male diabetic patient, who was an ex-smoker, hypertensive and with alcohol-related liver disease, was admitted to the surgical block of Pasteur Hospital (Montevideo, Uruguay) owing to a necrotising ischaemic lesion on the first toe of the left foot. The affected toe was amputated and a bone tissue sample was submitted to the hospital’s laboratory. 2.2. Bacterial identification and susceptibility assays Bacterial identification and the antibiotic susceptibility profile of the isolated micro-organisms were determined using a VITEK 1 2 Compact System (bioMe ´ rieux, Marcy l’E ´ toile, France). In addition, susceptibility to chloramphenicol and cefoxitin was assessed by disc diffusion test in Mueller–Hinton agar (Oxoid Ltd., Basingstoke, UK) and the results were interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines [7]. 2.3. Conjugation assays Conjugation assays were carried out using rifampicin-resistant Escherichia coli J53-2 as recipient. Transconjugants were selected on MacConkey agar plates (Oxoid Ltd.) supplemented with Journal of Global Antimicrobial Resistance 2 (2014) 77–81 A R T I C L E I N F O Article history: Received 14 August 2013 Received in revised form 27 December 2013 Accepted 2 January 2014 Keywords: Extended-spectrum b-lactamase ESBL Plasmid-mediated quinolone resistance PMQR Integron A B S T R A C T Here we report the detection of a Leclercia adecarboxylata strain, isolated from a case of osteomyelitis, harbouring multiple antibiotic resistance genes encoded on a 450-kb IncHI1/HI2 conjugative plasmid (pLa12). The plasmid carried a complex class 1 integron with the genetic array intI1–aac(6 0 )-Ib-cr–bla OXA- 1 –catB3–arr3–qacED1–sul1–ISCR1; in addition, a bla DHA-1 -like allele linked to ampR–qacED1–sul1 as well as bla SHV–12 , bla TEM-1 and qnrB4-like genes were found. To the best of our knowledge, this is the first report of L. adecarboxylata harbouring transferable resistance genes to quinolones, chloramphenicol and rifampicin as well as a plasmidic class C b-lactamase. ß 2014 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +598 2 487 57 95; fax: +598 2 487 57 95. E-mail address: rvignoli@higiene.edu.uy (R. Vignoli). Contents lists available at ScienceDirect Journal of Global Antimicrobial Resistance jo u rn al h om ep age: w ww.els evier.c o m/lo c ate/jg ar 2213-7165/$ – see front matter ß 2014 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jgar.2014.01.002