Title:Ralstonia Mannitolilytica, an Unusual Pathogen in the Neonatal Intensive Care Unit: A Case of Neonatal Sepsis and Literature Review
Volume: 21
Issue: 2
Author(s): Panagiotis Lampropoulos*, Despoina Gkentzi, Sotirios Tzifas, Georgia Kapnisi, Ageliki Karatza, Fevronia Kolonitsiou and Gabriel Dimitriou
Affiliation:
- Department of Pediatrics and Neonatology, University General Hospital of Patras, Patras,Greece
Keywords:
Sepsis, bacteraemia, neonate, gram-negative, Ralstonia spp., resistance.
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, 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 (endotracheal
tube tip cultures) isolated meropenem- and gentamicin-resistant strain of rare pathogen Ralstonia
mannitolilytica. Ralstonia spp. are aerobic, Gram-negative, lactose non-fermenting, oxidaseand
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 regard to early detection of
unusual pathogens, the emergence of antibiotic resistance patterns, and the obligation for adherence
to infection control policies.
