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. 2023 Aug 21;38(33):e252.
doi: 10.3346/jkms.2023.38.e252.

Clinical Manifestation of Ralstonia mannitolilytica Infection in Pediatric Patients and Epidemiological Investigation of Outbreaks

Gahee Kim  1 , Ree Nar Yoo  1 , Hyejin So  1 , Jeong-Young Lee  2 , Mi-Na Kim  3   2 , Sung-Han Kim  4   2 , Won Kyoung Jhang  1 , Seong Jong Park  1 , Jina Lee  1   5
Affiliations

Clinical Manifestation of Ralstonia mannitolilytica Infection in Pediatric Patients and Epidemiological Investigation of Outbreaks

Gahee Kim et al. J Korean Med Sci. .

Abstract

Background: Ralstonia mannitolilytica is a causative organism of nosocomial infections, particularly associated with contaminated water, and resistant to various antibiotics, including carbapenems. Several clusters of R. mannitolilytica infections appeared in children at our institute from August 2018 to November 2019.

Methods: From March 2009 to March 2023, all patients admitted to Asan Medical Center Children's Hospital in Seoul, Korea, with culture-confirmed R. mannitolilytica and corresponding clinical signs of infection were identified. Epidemiological and environmental investigations were conducted. Polymerase chain reaction (PCR) was performed for the genes of OXA-443 and OXA-444 on R. mannitolilytica isolates.

Results: A total of 18 patients with R. mannitolilytica infection were included in this study, with 94.4% (17/18) and 5.6% (1/18) being diagnosed with pneumonia and central line-associated bloodstream infection, respectively. All-cause 30-day mortality rate was 61.1% (11/18), and seven of the fatal cases were caused by R. mannitolilytica infection itself. The resistance rates to meropenem and imipenem werew 94.4% (17/18) and 5.6% (1/18), respectively. Although four out of nine meropenem-resistant R. mannitolilytica isolates had positive PCR results for OXA-443 and OXA-444 genes, there were no significant differences in antimicrobial susceptibility patterns. Environmental sampling identified R. mannitolylica at two sites: a cold-water tap of a water purifier and an exhalation circuit of a patient mechanical ventilator. After implementing and improving adherence to infection control policies, no additional R. mannitolilytica infection cases have been reported since December 2019.

Conclusion: R. mannitolilytica can cause life-threatening infections with high mortality in fragile pediatric populations. To prevent outbreaks, healthcare workers should be aware of R. mannitolilytica infections and strive to comply with infection control policies.

Keywords: Children; Infection Control; Outbreak; Ralstonia mannitolilytica.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Epidemic curve of Ralstonia mannitolilytica infection in children’s hospital from June 2016 to September 2019.
PICU = pediatric intensive care unit, PHO = pediatric hemato-oncology, NICU = neonatal intensive care unit.
See this image and copyright information in PMC

References

    1. Fang Q, Feng Y, Feng P, Wang X, Zong Z. Nosocomial bloodstream infection and the emerging carbapenem-resistant pathogen Ralstonia insidiosa . BMC Infect Dis. 2019;19(1):334. - PMC - PubMed
    1. Ryan MP, Adley CC. Ralstonia spp.: emerging global opportunistic pathogens. Eur J Clin Microbiol Infect Dis. 2014;33(3):291–304. - PubMed
    1. Lucarelli C, Di Domenico EG, Toma L, Bracco D, Prignano G, Fortunati M, et al. Ralstonia mannitolilytica infections in an oncologic day ward: description of a cluster among high-risk patients. Antimicrob Resist Infect Control. 2017;6(1):20. - PMC - PubMed
    1. Gröbner S, Heeg P, Autenrieth IB, Schulte B. Monoclonal outbreak of catheter-related bacteraemia by Ralstonia mannitolilytica on two haemato-oncology wards. J Infect. 2007;55(6):539–544. - PubMed
    1. Basso M, Venditti C, Raponi G, Navazio AS, Alessandri F, Giombini E, et al. A case of persistent bacteraemia by Ralstonia mannitolilytica and Ralstonia pickettii in an intensive care unit. Infect Drug Resist. 2019;12:2391–2395. - PMC - PubMed

Supplementary concepts