[Avoidable "fever of unknown origin" due to Ralstonia pickettii bacteremia]

Ralstonia pickettii bacteraemia from the atrial part of a ventriculo-atrial shunt was diagnosed as the cause of recurring febrile episodes with systemic toxicity in a 38-year old female. A prior neurosurgical resection of intracerebral cavernoma was complicated by postoperative recurrent meningitis with this non-fermenting gram-negative rod, due to an intra-operative contamination of a in situ shunt, from which only the intracerebral part of the ventriculo-atriostomy had been removed, following the episodes of meningitis. Ralstonia pickettii is a rare isolate and is seldom identified as a human pathogen. It formerly belonged to the genera Pseudomonas and Burkholderia. There are some casuistic reports of nosocomial bacteraemias, associated with the use of contaminated IV products or aerosols. There was an important diagnostic delay due to (1) insufficient communication between the different medical doctors in several hospitals, in different episodes of the clinical follow-up and (2) a misinterpretation of a positive blood culture with R. pickettii, which was interpreted as contamination. This misinterpretation and insufficient data transfer caused a considerable delay in the diagnostic process.