Related Experiment Video
Updated: Aug 31, 2025
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Ralstonia mannitolilytica: an emerging multidrug-resistant opportunistic pathogen in a tertiary care hospital setting
Tasneem Siddiqui1, Sangram Singh Patel1, Richa Sinha1
1Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Introduction:
Ralstonia mannitolilytica is a rare opportunistic pathogen capable of causing a serious infection in immunocompromised patients. Our objective was to describe all cases of R. mannitolilytica bloodstream infection identified within 2 years at our tertiary care centre, focusing on clinical characteristics, risk factors, antibiotic sensitivity patterns, management and outcomes.
Case Series:
We compiled a descriptive case series including 14 non-duplicate R. mannitolilytica isolates obtained from bloodstream infection samples from the microbiology laboratory of a tertiary care centre from June 2019 to June 2021. All isolates were initially identified based on their morphological properties and biochemical reactions, and then underwent matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) examination for confirmation of identity. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method and Vitek 2. All 14 patients presented with symptoms of fever and/or chills, and a positive blood culture for R. mannitolilytica . After 48 h of incubation, no Ralstonia growth was reported from any of the current environmental or pharmaceutical water samples. Chemotherapy (9/14), mechanical ventilation (4/14), steroid use (2/14) and diabetes mellitus (1/14) were associated risk factors in our patients. The antibiotic sensitivity panel showed maximum resistance to aminoglycosides (64.3%) and no resistance to cefoperazone/sulbactum. Patients received treatment with cefoperazone/sulbactum and meropenem or ceftazidime. Thirteen patients recovered with antibiotic therapy and one patient succumbed to his illness.
Conclusion:
R. mannitolilytica can cause bloodstream infections in immunocompromised patients. It is likely to be missed or underreported due to lack of clinical awareness. MALDI-TOF MS is helpful in rapid identification. R. mannitolilytica is resistant to many routinely used antibiotics, including carbapenems.
Insights
Ralstonia mannitolilytica bloodstream infections are rare but serious in immunocompromised patients. Cefoperazone/sulbactum showed effectiveness against R. mannitolilytica, with most patients recovering.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Pathology
Background:
- Ralstonia mannitolilytica is an opportunistic pathogen causing rare but severe infections, particularly in immunocompromised individuals.
- Clinical awareness and rapid diagnostics are crucial for identifying R. mannitolilytica infections, which may be underreported.
- This study focuses on bloodstream infections caused by R. mannitolilytica in a tertiary care setting.
Purpose of the Study:
- To describe clinical characteristics, risk factors, and outcomes of R. mannitolilytica bloodstream infections.
- To analyze antibiotic sensitivity patterns of R. mannitolilytica isolates.
- To evaluate management strategies and treatment outcomes for R. mannitolilytica infections.
Main Methods:
- A descriptive case series of 14 R. mannitolilytica bloodstream infection isolates identified over two years (June 2019-June 2021).
- Isolate identification confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS).
- Antibiotic susceptibility testing performed via Kirby-Bauer disc diffusion and Vitek 2 systems.
Main Results:
- All 14 patients presented with fever and/or chills and positive blood cultures for R. mannitolilytica.
- Identified risk factors included chemotherapy (9/14), mechanical ventilation (4/14), steroid use (2/14), and diabetes mellitus (1/14).
- Significant resistance observed against aminoglycosides (64.3%), with no resistance to cefoperazone/sulbactum. Thirteen patients recovered; one patient died.
Conclusions:
- R. mannitolilytica bloodstream infections pose a significant threat to immunocompromised patients.
- MALDI-TOF MS aids in the rapid and accurate identification of R. mannitolilytica.
- Cefoperazone/sulbactum demonstrated efficacy, offering a potential treatment option against this resistant pathogen.
Related Concept Videos
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...