Ralstonia Mannitolilytica, an Unusual Pathogen in the Neonatal Intensive Care Unit: A Case of Neonatal Sepsis and Literature Review

Abstract

Background: Premature infants are considered high-risk subgroup for neonatal sepsis due to yet defective immune system, interventions practised and synergy of factors favoring multiple resistance of Gram-positive and Gram-negative pathogens to antimicrobial agents. Case presentation: We present a case of late-onset neonatal sepsis in a premature infant caused by an uncommon pathogen; a premature infant of extremely low birth weight had in his 4th week of life severe clinical deterioration with lethargy, fever, pallor, 1 mottling, abdominal distention, tachycardia, and worsening respiratory impairment. Full septic screen was performed, broad-spectrum antibiotic therapy was initiated and supportive care per needs was provided. Blood cultures (and endotracheal tube tip cultures) isolated meropenem- and gentamicin-resistant strain of rare pathogen Ralstonia mannitolilytica. Ralstonia spp are aerobic, Gram-negative, lactose nonfermenting, oxidase- and catalase-positive bacilli, thriving in water and soil. Ralstonia spp are identified only sporadically as causative agents of neonatal sepsis; to our knowledge this is the second report of neonatal sepsis due to R. mannitolilytica in the literature so far. Our patient was eventually treated (per sensitivity pattern) with intravenous ciprofloxacin, and recovered well from the infection. Conclusion: We intend to raise awareness among neonatologists with regards to early detection of unusual pathogens, emergence of antibiotic resistance patterns, and obligation for adherence to infection control policies.

Ralstonia mannitolilytica sepsis in neonatal intensive care unit – Be(a)ware of the multidrug resistant nosocomial bug

“…This has been rarely reported in the literature till now. [2][3][4] Ralstonia species are Gram-negative bacilli found in soil, water and plants and can thrive in low-nutrient conditions in various types of hospital water supplies leading to outbreaks. 5 We had six babies in level III of our neonatal intensive care unit during the outbreak.…”

Ralstonia mannitolilytica: an emerging multidrug-resistant opportunistic pathogen in a tertiary care hospital setting

“…R. mannitolilytica are known to cause sepsis, meningitis and central venous catheterassociated bacteraemia [3]. Of late several case reports of infections by R. mannitolilytica have been seen from India and worldwide [4][5][6][7][8][9][10][11][12]. Many case reports have highlighted R. mannitolilytica as causing bacteraemia and sepsis [4][5][6][7][8][9][10][11].…”

“…Of late several case reports of infections by R. mannitolilytica have been seen from India and worldwide [4][5][6][7][8][9][10][11][12]. Many case reports have highlighted R. mannitolilytica as causing bacteraemia and sepsis [4][5][6][7][8][9][10][11]. Lampropoulos et al (2021) and Rajendran et al (2022) highlighted the organism as an emerging opportunistic pathogen causing sepsis in neonatal intensive care units [9,10] .…”

“…Of late several case reports of infections by R. mannitolilytica have been seen from India and worldwide [4–12]. Many case reports have highlighted R.…”

“…Many case reports have highlighted R. mannitolilytica as causing bacteraemia and sepsis [4][5][6][7][8][9][10][11]. Lampropoulos et al (2021) and Rajendran et al (2022) highlighted the organism as an emerging opportunistic pathogen causing sepsis in neonatal intensive care units [9,10] . Carreira et al (2020) emphasized the role of R. mannitolilytica in endocarditis [12].…”