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Moradi F, Rajaee behbahani M, Gorginpour J, Dezhkam A, Hadi N. Ralstoniapickettii bloodstream infection in the patient with Guillain-Barre syndrome under plasmapheresis. New Microbes New Infect 2024; 57:101218. [PMID: 38298270 PMCID: PMC10828895 DOI: 10.1016/j.nmni.2024.101218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 12/25/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
Ralstonia pickettii is a rare Gram-negative opportunistic bacterium that causes rare infections such as bacteremia, neonatal sepsis, endocarditis, and meningitis in hospitalized or immunocompromised patients. In this study, we identified and reported bloodstream infection caused by R. pickettii in a 15 -year-old boy patient with an autoimmune disease, Guillain-Barré syndrome, under plasmapheresis and intravenous immune globulin (IVIG) therapy. He was referred for admission to the neurology center of the teaching hospital of Shiraz, Iran for inability to walk, and lower extremity muscle weakness. After he was treated with plasmapheresis once during hospitalization, and after severe fever besides shivering blood cultures using BACT/ALERT®3D instrument were positive for R. pickettii.According to antibiotic susceptibility test reports, Ciprofloxacin (5 μg) was prescribed. Fortunately, after starting antibiotic treatment, blood culture results reported no growth after 5 days. Indeed, the patient was infected with nosocomial hepatitis A and URSOBIL (300 mg/BID/Po) was administered. Hence, after reporting the infection occurrence to the hospital infection control unit, initial and possible measures such as device infection control, replacement of potentially polluted plasmapheresis fluids, disinfecting the environment and replacing old sterile washing water with new sources were carried out in plasmapheresis unit. In conclusion, R. pickettii is a rare nosocomial infection that is responsible for the contamination of medical equipment, especially in hemodialysis, plasmapheresis devices and sterile solutions. Also, it is suggested that the role and importance of rare environmental bacteria as the causative agents of human infections should not be ignored in medical centers.
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Affiliation(s)
- Farhad Moradi
- Department of Bacteriology & Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahrokh Rajaee behbahani
- Department of Bacteriology & Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javid Gorginpour
- Department of Medical Laboratory Science, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Asiyeh Dezhkam
- Department of Pediatric Infectious Disease, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahal Hadi
- Department of Bacteriology & Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Batarilo I, Maravic-Vlahovicek G, Bedenic B, Kazazic S, Bingulac Popovic J, Slade Vitkovic M, Katic S, Jukic I. Oxacillinases and antimicrobial susceptibility of Ralstonia pickettii from pharmaceutical water systems in Croatia. Lett Appl Microbiol 2022; 75:103-113. [PMID: 35352370 DOI: 10.1111/lam.13711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/03/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Abstract
This study evaluated antibiotic susceptibility and presence of blaOXA22 and blaOXA60 genes in 81 isolates of Ralstonia pickettii obtained from different purified and ultra-pure water systems in two different geographical areas of Croatia. E-test and disk diffusion test were performed to determine antibiotic susceptibility. Polymerase Chain Reaction was applied to detect genes encoding OXA-22 and OXA-60, oxacillinases previously identified in R. pickettii. The isolates were genotyped by pulsed-field gel electrophoresis. The results revealed variable susceptibility/resistance profiles. Our isolates exhibited high susceptibility rates to ceftriaxone, cefotaxime, piperacillin-tazobactam, ciprofloxacin, imipenem, cefepime and in lesser extent to ceftazidime. High rates of susceptibility were also observed for sulfamethoxazole-trimethoprim and piperacillin. High resistance rates were noticed for ticarcillin-clavulanate, aztreonam and meropenem, as well as for all aminoglycosides tested. Modified Hodge test was positive in 51,9% strains, indicating production of carbapenemases. blaOXA22 and blaOXA60 genes were detected in 37.0% and 80.3% strains, respectively. Pulsed-field gel electrophoresis identified three major clusters containing subclusters. R. pickettii should be taken seriously as a possible cause of nosocomial infections to ensure adequate therapy, to prevent the development of resistant strains and to try to reduce the possibility of R. pickettii surviving in clean and ultra clean water systems.
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Affiliation(s)
- I Batarilo
- Croatian Institute for Transfusion Medicine, Zagreb, Croatia
| | | | - B Bedenic
- School of Medicine, University of Zagreb, Croatia.,University Hospital Center Zagreb, Croatia
| | - S Kazazic
- Ruđer Bošković Institute, Zagreb, Croatia
| | | | | | - S Katic
- School of Medicine, University of Zagreb, Croatia
| | - I Jukic
- Croatian Institute for Transfusion Medicine, Zagreb, Croatia.,Josip Juraj Strossmayer University of Osijek, Croatia
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Microbiological Evaluation of Water Used in Dental Units. WATER 2022. [DOI: 10.3390/w14060915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In modern dentistry, dental units are used for the treatment of patients’ teeth, and they need water to operate. Water circulates in a closed vessel system and finally reaches the mucous membranes of the patient as well as the dentist themselves. Therefore, the microbiological safety of this water should be a priority for physicians. This study aims to identify and determine the microbial count, expressed in CFU/mL, in water samples from various parts of the dental unit that are in direct contact with the patient. Thirty-four dental units located in dentistry rooms were analysed. The dentistry rooms were divided into three categories: surgical, conservative, and periodontal. It was found that in surgical rooms, the bacterial count was 1464.76 CFU/mL, and the most common bacterium was Staphylococcus pasteuri—23.88% of the total bacteria identified. In dentistry rooms where conservative treatments were applied, the average bacterial concentration was 8208.35 CFU/mL, and the most common bacterium was Ralsonia pickettii (26.31%). The periodontal rooms were also dominated by R. pickettii (45.13%), and the average bacterial concentration was 8743.08 CFU/mL. Fungi were also detected. Rhodotorula spp., Alternaria spp., and Candida parapsilosis were found to be the most common bacteria which are potentially harmful. This study indicates the need for effective decontamination of the water that is used in dental units and for constant monitoring of the level of contaminants present in the closed vessel system.
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Basso M, Venditti C, Raponi G, Navazio AS, Alessandri F, Giombini E, Nisii C, Di Caro A, Venditti M. A case of persistent bacteraemia by Ralstonia mannitolilytica and Ralstonia pickettii in an intensive care unit. Infect Drug Resist 2019; 12:2391-2395. [PMID: 31447567 PMCID: PMC6686741 DOI: 10.2147/idr.s206492] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
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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Affiliation(s)
- Monica Basso
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Carolina Venditti
- Laboratory of Microbiology, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome Italy
| | - Anna Sara Navazio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome Italy
| | - Francesco Alessandri
- Department of Anesthesia and Intensive Care Medicine, Sapienza University of Rome, Rome, Italy
| | - Emanuela Giombini
- Laboratory of Microbiology, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Carla Nisii
- Laboratory of Microbiology, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Antonino Di Caro
- Laboratory of Microbiology, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome Italy
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Nasir N, Sayeed MA, Jamil B. Ralstonia pickettii Bacteremia: An Emerging Infection in a Tertiary Care Hospital Setting. Cureus 2019; 11:e5084. [PMID: 31516793 PMCID: PMC6721917 DOI: 10.7759/cureus.5084] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Ralstonia species are Gram-negative bacilli that have increasingly been recognized as emerging nosocomial pathogens, particularly in immunocompromised hosts. Ralstonia pickettii is the most clinically important pathogen from the Ralstonia genus. Nosocomial outbreaks of Ralstonia pickettii infections brought about by the use of contaminated medical solutions, including saline, sterile water, as well as disinfectants, have been reported. There have been case reports of invasive infections with variable presentations. Here, we describe three cases of Ralstonia pickettii bacteremia during a period of one year in a tertiary care hospital in Karachi, Pakistan. The first case was a 76-year-old male, known case of type 2 diabetes mellitus (DM), hypertension, and amyotrophic lateral sclerosis, who presented with complaints of burning micturition, hematuria, and fever. The patient had a history of multiple hospital admissions in the recent past. His blood culture was found to be positive for Ralstonia pickettii. A computed tomography scan of the kidneys, ureter, and bladder (CT KUB) was suggestive of pyelonephritis. The patient improved on intravenous meropenem. The second case was a 47-year-old man, who was admitted with a gunshot injury to the neck, resulting in complete cervical cord resection and mild hydrocephalus with intraventricular hemorrhage. The patient had a prolonged intensive care unit (ICU) stay, which was complicated by ventilator-associated pneumonia with Acinetobacter and central line-associated bloodstream infection (CLABSI) with Ralstonia pickettii. He was treated with meropenem and colistin but continued to deteriorate and expired. The third case was a 46-year-old lady, known case of end-stage renal disease (ESRD), who was admitted with prosthetic valve endocarditis. She had a prolonged hospital stay complicated by CLABSI with Ralstonia pickettii, improved on meropenem, but later died due to fungemia. Ralstonia pickettii is an emerging cause of nosocomial infection in patients, particularly those with a prolonged hospital stay, and can cause invasive and severe infections.
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Affiliation(s)
- Nosheen Nasir
- Internal Medicine, Aga Khan University Hospital, Karachi, PAK
| | | | - Bushra Jamil
- Internal Medicine, Aga Khan University Hospital, Karachi, PAK
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K Thet M, Pelobello MLF, Das M, Alhaji MM, Chong VH, Khalil MAM, Chinniah T, Tan J. Outbreak of nonfermentative Gram-negative bacteria (Ralstonia pickettii and Stenotrophomonas maltophilia) in a hemodialysis center. Hemodial Int 2019; 23:E83-E89. [PMID: 30746829 DOI: 10.1111/hdi.12722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We report a case series of seven patients with nonfermentative Gram-negative bacteria infections in a single dialysis center; four patients with Ralstonia pickettii and three patients with Stenotrophomonas maltophilia. Two of the seven patients were admitted to hospital for intravenous antibiotic treatment, while the rest were treated with oral antibiotics at home. Both the admitted patients had temporary vascular catheter infections from the aforementioned pathogens. We conclude that the outbreak is due to colonization of treated reverse osmosis water, presumably through contamination via polluted filters and compounded by the usage of reprocessed dialysers in the dialysis center. This is especially relevant because contaminated treated water is directly introduced into the blood compartment of the dialysers during reprocessing. In addition, there seems to be a propensity for both organisms to cause prolonged febrile reactions in patients with temporary vascular catheters, likely through the early development of biofilm. Intensification of general sterilization procedures, servicing and replacement of old decrepit components of the water treatment system and temporary cessation of dialyser reuse practice seem to have halted the outbreak. Due to the virulent nature and difficult resistant profile of nonfermentative Gram-negative bacteria, we strongly recommend meticulous vigilance in the surveillance of culture isolates in routine microbiological specimens from dialysis centers, especially if there is a senescent water treatment system and a practice of reprocessing dialysers.
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Affiliation(s)
- May K Thet
- Department of Renal Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | - Milton Das
- Department of Renal Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Mohammed M Alhaji
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
| | - Vui Heng Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | - Terence Chinniah
- Department of Microbiology, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Jackson Tan
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
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Tejera D, Limongi G, Bertullo M, Cancela M. Ralstonia pickettii bacteremia in hemodialysis patients: a report of two cases. Rev Bras Ter Intensiva 2017; 28:195-8. [PMID: 27410414 PMCID: PMC4943058 DOI: 10.5935/0103-507x.20160033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/22/2016] [Indexed: 12/23/2022] Open
Abstract
Ralstonia pickettii is a low-virulence gram-negative bacillus
that may be associated with infections related to health care and may cause
bacteremia. Ralstonia pickettii bacteremia is uncommon but is
related to the contamination of medical products, mainly in immunodepressed
patients. We present two cases of patients on chronic hemodialysis with
Ralstonia pickettii bacteremia linked to contamination of
the dialysis water. Similar cases have been published with links to intravenous
fluid administration, medication ampules, and the use of extracorporeal
oxygenation membranes, among other factors. The detection of Ralstonia
pickettii bacteremia should provoke suspicion and a search for
contaminated medical products, fluids, and/or medications.
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Native Valve Endocarditis due to Ralstonia pickettii: A Case Report and Literature Review. Case Rep Infect Dis 2015; 2015:324675. [PMID: 25648998 PMCID: PMC4306225 DOI: 10.1155/2015/324675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/10/2014] [Accepted: 12/17/2014] [Indexed: 11/17/2022] Open
Abstract
Ralstonia pickettii is a rare pathogen and even more rare in healthy individuals. Here we report a case of R. pickettii bacteremia leading to aortic valve abscess and complete heart block. To our knowledge this is the first case report of Ralstonia species causing infective endocarditis with perivalvular abscess.
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Vincenti S, Quaranta G, De Meo C, Bruno S, Ficarra MG, Carovillano S, Ricciardi W, Laurenti P. Non-fermentative gram-negative bacteria in hospital tap water and water used for haemodialysis and bronchoscope flushing: prevalence and distribution of antibiotic resistant strains. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 499:47-54. [PMID: 25173861 DOI: 10.1016/j.scitotenv.2014.08.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 05/28/2023]
Abstract
This study provides a detailed description of the distribution of non-fermentative gram-negative bacteria (NFGNB) collected in water sources (tap water and water used for haemodialysis and bronchoscope flushing) from different wards of a tertiary care hospital. The aim is to identify risk practices for patients or to alert clinicians to the possible contamination of environment and medical devices. The resistance profile of NFGNB environmental isolates has shown that more than half (55.56%) of the strains isolated were resistant to one or more antibiotics tested in different antimicrobial categories. In particular, 38.89% of these strains were multidrug resistant (MDR) and 16.67% were extensively drug resistant (XDR). The most prevalent bacterial species recovered in water samples were Pseudomonas aeruginosa, Pseudomonas fluorescens, Ralstonia pickettii and Stenotrophomonas maltophilia. Analysis of antibiotic resistance rates has shown remarkable differences between Pseudomonadaceae (P. aeruginosa and P. fluorescens) and emerging pathogens, such as S. maltophilia and R. pickettii. Multidrug resistance can be relatively common among nosocomial isolates of P. aeruginosa, which represent the large majority of clinical isolates; moreover, our findings highlight that the emergent antibiotic resistant opportunistic pathogens, such as R. pickettii and S. maltophilia, isolated from hospital environments could be potentially more dangerous than other more known waterborne pathogens, if not subjected to surveillance to direct the decontamination procedures.
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Affiliation(s)
- Sara Vincenti
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gianluigi Quaranta
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Concetta De Meo
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome 00168, Italy.
| | - Stefania Bruno
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Giovanna Ficarra
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Serena Carovillano
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Walter Ricciardi
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Patrizia Laurenti
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Ryan MP, Adley CC. Ralstonia spp.: emerging global opportunistic pathogens. Eur J Clin Microbiol Infect Dis 2013; 33:291-304. [DOI: 10.1007/s10096-013-1975-9] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/01/2013] [Indexed: 11/28/2022]
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Ryan MP, Adley CC. The antibiotic susceptibility of water-based bacteria Ralstonia pickettii and Ralstonia insidiosa. J Med Microbiol 2013; 62:1025-1031. [PMID: 23579396 DOI: 10.1099/jmm.0.054759-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Ralstonia pickettii and Ralstonia insidiosa are waterborne bacteria that can survive and grow in various water sources, and that are emerging pathogens in hospital settings. Not much is known about the antibiotic resistance of these bacteria. Previous reports of antimicrobial susceptibility have been largely limited to a few clinical strains with no accounting for genotypic or phenotypic diversity or that these species could vary from the set breakpoints. Etests and disc diffusion tests were carried out to compare the antimicrobial susceptibilities to 12 different antibiotics of 68 different isolates of R. pickettii (53) and R. insidiosa (15) from varying environments, which have previously been well characterized both phenotypically and genetically. The majority of the R. pickettii and R. insidiosa isolates showed susceptibility to most of the antibiotics tested in this study. The most effective were found to be the quinolones and sulfamethoxazole/trimethoprim. Antibiotic susceptibility was also found not to vary between environmental niches for R. pickettii and R. insidiosa isolates.
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Affiliation(s)
- Michael P Ryan
- Microbiology Laboratory, Department of Chemical and Environmental Sciences, University of Limerick, Limerick, Ireland
| | - Catherine C Adley
- Microbiology Laboratory, Department of Chemical and Environmental Sciences, University of Limerick, Limerick, Ireland
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