Ralstonia Pickettii Meningitis in a Child with Hydrocephalus

Bonatti, Hugo; Stelzmueller, Ingrid; Laimer, I.; Obwegeser, Alois Albert

doi:10.1055/s-0029-1202252

Cited by 13 publications

(10 citation statements)

References 7 publications

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“…In adults, fatal cases have been described in hematological patients (e.g. patients with leukemia) with immunosuppressive therapy and in patients with thalassemia that develop infection [22]. R. pickettii infection was also identified in patients with cochlear implants [23].…”

Section: Discussionmentioning

confidence: 99%

Sonication contribution to identifying prosthetic joint infection with Ralstonia pickettii: a case report and review of the literature

Bîrluţiu

Roman

Cismasiu

et al. 2017

BMC Musculoskelet Disord

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BackgroundIn the context of an increase number of primary and revision total hip and total knee arthroplasty performed yearly, an increased risk of complication is expected. Prosthetic joint infection (PJI) remains the most common and feared arthroplasty complication. Ralstonia pickettii is a Gram-negative bacterium, that has also been identified in biofilms. It remains an extremely rare cause of PJI. There is no report of an identification of R. pickettii on an extracted spacer loaded with antibiotic.Case presentationWe present the case of an 83-years-old Caucasian male patient, that underwent a right cemented total hip replacement surgery. The patient is diagnosed with an early PJI with no isolated microorganism. A debridement and change of mobile parts is performed. At the beginning of 2016, the patient in readmitted into the Orthopedic Department for sever, right abdominal and groin pain and elevated serum erythrocyte sedimentation rate and C-reactive protein. A joint aspiration is performed with a negative microbiological examination. A two-stage exchange with long interval management is adopted, and a preformed spacer loaded with gentamicin was implanted. In July 2016, based on the proinflammatory markers evolution, a shift a three-stage exchange strategy is decided. In September 2016, a debridement, and changing of the preformed spacer loaded with gentamicin with another was carried out. Bacteriological examination of the tissues sampled intraoperatively was positive for Pseudomonas aeruginosa. From the sonication fluid, no bacteria were isolated on culture or identified using the bbFISH assay. During the hospitalization period, the patient received i.v. ceftazidime 3x2g/day and p.o. ciprofloxacin 2x750mg/day, antibiotic therapy that was continued after discharge with p.o. ciprofloxacin 2x750mg/day for 6 weeks. In February 2017, a reimplantation of a revision prosthesis is performed. The retrieved spacer is sonicated, and after 4 days of incubation of the sonication fluid, R. pickettii is isolated. A long term antibiotic therapy with cotrimoxazole being prescribed.ConclusionsBacteria culture of sonication fluid remains the gold standard in diagnosing prosthetic joint infections. R. pickettii remains an extremely rare cause of prosthetic joint infection. Optimal management of R. pickettii prosthetic joint infections of has not been established.

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Section: Discussionmentioning

confidence: 99%

Sonication contribution to identifying prosthetic joint infection with Ralstonia pickettii: a case report and review of the literature

Bîrluţiu

Roman

Cismasiu

et al. 2017

BMC Musculoskelet Disord

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“…Members of the Ralstonia genus are emerging opportunistic pathogens that include R. pickettii, R. mannitolilytica, R. solanacearum , and R. insidiosa. R. pickettii and R. mannitolilytica have been involved in a wide spectrum of infections in hospital settings 1–4. Frequent reports of infections associated with these non-fermenting Gram-negative rods, as well as their resistance to many classes of antibiotics, have determined a rise in attention for these pathogens in recent years 5–7…”

Section: Introductionmentioning

confidence: 99%

A case of persistent bacteraemia by Ralstonia mannitolilytica and Ralstonia pickettii in an intensive care unit

Basso¹,

Venditti²,

Raponi³

et al. 2019

IDR

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The Ralstonia spp . genus is a group of non-fermentative, Gram-negative bacteria often resistant to many antibiotics, which are emerging as opportunistic pathogens frequently associated with infections in hospital settings. We present herein a case of combined R. pickettii and R. mannitolilytica persisting and relapsing bacteraemia, possibly caused by a septic arterial thrombosis secondary to the rupture of an internal carotid artery aneurysm. Microbiology studies showed that both Ralstonia isolates produced biofilm and carried class D oxacillinase genes. When confronted with infections caused by members of the Ralstonia genus, identification to the species level is crucial for correct clinical management, as the two species show different antibiotic susceptibility patterns.

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“…Ralstonia spp. is reported as a causative agent of bacteremia [ 3 , 4 ], meningitis [ 5 , 6 ], and sepsis [ 7 , 8 ] in immunocompromised patients and of central venous catheter (CVC)-associated bacteremia in oncology patients [ 1 – 4 , 9 ]. Several hospital outbreaks have been described that were associated with contaminated solutions, including water for injection, saline solutions, disinfectants and antiseptics [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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

Lucarelli

Domenico

Toma

et al. 2017

Antimicrob Resist Infect Control

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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.

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Ralstonia Pickettii Meningitis in a Child with Hydrocephalus

Cited by 13 publications

References 7 publications

Sonication contribution to identifying prosthetic joint infection with Ralstonia pickettii: a case report and review of the literature

Sonication contribution to identifying prosthetic joint infection with Ralstonia pickettii: a case report and review of the literature

<p>A case of persistent bacteraemia by <em>Ralstonia mannitolilytica</em> and <em>Ralstonia pickettii</em> in an intensive care unit</p>

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

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