Ralstonia mannitolilytica infections in an oncologic day ward: description of a cluster among high-risk patients

Abstract

Background Ralstonia spp, an environmental microorganism, has been occasionally associated with healthcare infections. The aim of this study was to investigate an outbreak caused by Ralstonia mannitolilytica in oncology patients.MethodsCase definition: Oncology outpatients attending a day ward, with positive blood and/or central venous catheter (CVC) culture for Ralstonia spp from September 2013 – June 2014. We analysed medical records, procedures and environmental samples. R. mannitolilytica was identified by 16S rRNA sequencing, and typed by Pulsed Field Gel Electrophoresis (PFGE); resistance to carbapenemes was investigated by phenotypic and molecular methods.ResultsThe patients (N = 22) had different malignancies and received different therapy; all had a CVC and 16 patients presented chills and/or fever. R. mannitolilytica was isolated from both blood and CVC (n = 12) or only blood (n = 6) or CVC tips (n = 4). The isolates had indistinguishable PFGE profile, and showed resistance to carbapenems. All the isolates were negative for carbapenemase genes while phenotypic tests suggests the presence of an AmpC β-lactamase activity,responsible for carbapenem resistance. All patients had had CVC flushed with saline to keep the venous access pervious or before receiving chemotherapy at various times before the onset of symptoms. After the first four cases occurred, the multi-dose saline bottles used for CVC flushing were replaced with single-dose vials; environmental samples were negative for R. mannitolilytica. ConclusionsAlthough the source of R. mannitolilytica remains unidentified, CVC flushing with contaminated saline solution seems to be the most likely origin of R. mannitolilytica CVC colonization and subsequent infections. In order to prevent similar outbreaks we recommend removal of any CVC that is no longer necessary and the use of single-dose solutions for any parenteral treatment of oncology patients.

Ralstonia mannitolilytica bacteremia in a neonatal intensive care unit

“…In addition to the multidrug resistance presented, other risk factors contribute to the acquisition of a Ralstonia spp. infection, like the potential for biofilm formation 6 and its ability to pass through 0.2-μm filters, which are used for the sterilization of many medical products 3 .…”

Methylene blue decolorizing bacteria isolated from water sewage in Yogyakarta, Indonesia

“…Isolate PMB-2 was thought to be the genus Pseudomonas based on the biochemical characteristics (Ryan et al 2011). Ralstonia mannitolilytica was previously identified as Pseudomonas thomasii, which is commonly found in soil and water and mostly present in industrial and polluted biotopes, and metallurgic wastes (Lucarelli et al 2017). R. mannitolilytica was previously reported as cadmium bioremediating bacteria (Ojuederie and Babalola 2017).…”

Microbiological examination of nonsterile Cannabis products

“…Ralstonia is a plant and human pathogenic bacteria found in cannabis and is known to infect many fungi found on Cannabis 60,61 . Several clinical reports of Ralstonia infections in exist in Cancer patients, Cystic Fibrosis patients and other immunecompromised patients [62][63][64] . It is unlikely that bacteria internal to a fungi will produce colonies on bacterial petri dishes.…”