Ralstonia insidiosa Neonatal Sepsis: A Case Report and Review of the Literature

Abstract

Introduction Ralstonia spp. are nonfermenting gram-negative bacteria that have recently emerged as opportunistic pathogens. Previously, two case series of infection associated with Ralstonia insidiosa have been published. In this case report, R. insidiosa infection of a neonate in the neonatal intensive care unit (NICU) is presented. Case Presentation A term male infant developed respiratory distress 2 hours after birth and was admitted to the NICU with the presumptive diagnosis of transient tachypnea of the newborn. A left apical pneumothorax was detected, requiring chest tube insertion. An umbilical catheter was placed due to poor peripheral vascular access. On the second day, blood cultures were sent from the umbilical artery and umbilical venous catheters, which showed growth of R. insidiosa. The antibiotics were changed from ampicillin and gentamicin to ampicillin–sulbactam and cefotaxime according to the antibiotic susceptibility test results. Respiratory distress symptoms resolved and the patient was extubated. The infant's clinical condition improved steadily and was discharged with breast feeding and stable vital findings, negative follow-up cultures, and C-reactive protein. Conclusion Ralstonia insidiosa is an emerging pathogen in hospital infections due to its ability to survive in water supplies and sterilized water-based solutions. There is need for vigilance of R. insidiosa, especially in intensive care units. Awareness of rare pathogens, early detection of the bacteria, and antibiotic susceptibility test results are important in the success of treatment.

Ralstonia insidiosa Bacteremia in Patients with Solid Cancer Treated by Means of a Central Venous Catheter

“…We could not confirm this hypothesis for the late identification of the cluster, since R. insidiosa was not among the alert agents routinely sought by our laboratory-based infection control system. Nonetheless, Gram-negative and biofilm-producing bacteria are capable of surviving on the surface of the chlorhexidine bottles used for routine antisepsis, as previously reported [9][10][11].…”

Identification and Elimination of the Clinically Relevant Multi-Resistant Environmental Bacteria Ralstonia insidiosa in Primary Cell Culture

“…Despite their clinical relevance as opportunistic multidrug-resistant global pathogens [ 20 ] and their emergence as causative agents of nosocomial infections [ 41 , 43 , 44 , 45 ], publicly available genome sequences of R. insidiosa are rare. Therefore, we sequenced our isolate to perform a phylogenetical comparison to published Ralstonia spp.…”

“…Along with R. pickettii , R. mannitolilytica , and R. insidiosa are the most relevant pathogens of the Ralstonia genus and are considered as emerging opportunistic pathogens with increasing clinical relevance [ 41 ]. Infections with R. insidiosa can range from minor superficial infections to more severe systemic infections, i.e., bacteremia, even in newborns [ 28 , 41 , 44 , 45 ].…”

Transcriptomic and metabolomic analyses to study the key role by which Ralstonia insidiosa induces Listeria monocytogenes to form suspended aggregates

“…Ralstonia insidiosa is a non-fermenting, aerobic, Gram-negative bacterium that often causes infections as a conditional pathogen (Coenye et al, 2003 ; Alaşehir et al, 2020 ). As an environmental bacterium, R. insidiosa can be found in a wide range of aqueous environments such as industrial water, laboratory pure water, and hospital water systems, as well as in rivers, ponds, and soils.…”