An outbreak of Ralstonia pickettii bloodstream infection and clinical outcomes

  • Şirin Menekşe Department of Infectious Diseases, Koşuyolu Kartal Heart Training and Research Hospital, İstanbul, Turkey
  • Demet Hacıseyitoğlu Bulent Ecevit University Faculty of Medicine, Department of Medical Microbiology, Zonguldak, Turkey
  • Serap Süzük Yıldız National Molecular Microbiology Reference Laboratory, Public Health General Directorate, Ministry of Health, Ankara, Turkey
  • Fatma Bayrakdar National Molecular Microbiology Reference Laboratory, Public Health General Directorate, Ministry of Health, Ankara, Turkey
Keywords: Ralstonia pickettii, hospital outbreak, low virulence

Abstract

Introduction: Ralstonia pickettii infections are rare and may be mistaken for other bacteria. This study aims to report a hospital outbreak of R. pickettii at a tertiary hospital, which was initially misidentified as Ralstonia insidiosa, along with its clinical consequences.

Methodology: A bacteraemia outbreak occurred between August 14 and October 4, 2019, infecting 22 patients admitted to diverse intensive care units. All isolates were identified with the use of the automated VITEK 2 Compact system and were then subjected to a microbial identification system, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Bacterial identification and genomic DNA typing was made using pulsed-field gel electrophoresis. Investigation covered all potential sources of the outbreak.

Results: An index patient and five additional patients developed fever while receiving care. Blood cultures of these patients yielded R. insidiosa by the VITEK 2 Compact system. Culture isolates were then submitted to a reference centre for confirmation by the MALDI-TOF MS system, where the bacterium turned out to be R. pickettii. No pathogen was isolated in the commercial products except for three samples of unopened sterile distilled water. Despite its discontinuation, 16 new cases were identified, in which blood cultures grew R. pickettii by the MALDI-TOF MS system. Attempts to uncover the source of the outbreak failed. Clinical manifestation was confined to fever in all the patients.

Conclusions: During this outbreak, R. pickettii infections ran a relatively mild course without clinical deterioration or mortality, possibly due to low virulence.

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Published
2022-04-30
How to Cite
1.
Menekşe Şirin, Hacıseyitoğlu D, Süzük YıldızS, Bayrakdar F (2022) An outbreak of Ralstonia pickettii bloodstream infection and clinical outcomes. J Infect Dev Ctries 16:705-711. doi: 10.3855/jidc.15159
Section
Original Articles