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Journal of Korean Medical Science Aug 2023is a causative organism of nosocomial infections, particularly associated with contaminated water, and resistant to various antibiotics, including carbapenems. Several...
BACKGROUND
is a causative organism of nosocomial infections, particularly associated with contaminated water, and resistant to various antibiotics, including carbapenems. Several clusters of 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 and corresponding clinical signs of infection were identified. Epidemiological and environmental investigations were conducted. Polymerase chain reaction (PCR) was performed for the genes of and on isolates.
RESULTS
A total of 18 patients with 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 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 isolates had positive PCR results for and genes, there were no significant differences in antimicrobial susceptibility patterns. Environmental sampling identified 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 infection cases have been reported since December 2019.
CONCLUSION
can cause life-threatening infections with high mortality in fragile pediatric populations. To prevent outbreaks, healthcare workers should be aware of infections and strive to comply with infection control policies.
Topics: Humans; Child; Meropenem; Disease Outbreaks; Anti-Bacterial Agents; Hospitals, Pediatric
PubMed: 37605494
DOI: 10.3346/jkms.2023.38.e252 -
Jundishapur Journal of Microbiology Jul 2016Ralstonia mannitolilytica is an emerging opportunistic pathogen. Hospital outbreaks of Ralstonia spp. are mainly associated with contaminated treatment water or...
BACKGROUND
Ralstonia mannitolilytica is an emerging opportunistic pathogen. Hospital outbreaks of Ralstonia spp. are mainly associated with contaminated treatment water or auxiliary instruments.
OBJECTIVES
In this report, we summarize the clinical infection characteristics of R. mannitolilytica, the drug-susceptibility testing of the bacterial strains, and the results of related infection investigations.
PATIENTS AND METHODS
We retrospectively analyzed the clinical information of 3 patients with R. mannitolilytica.
RESULTS
The patients' primary-onset symptoms were chills and fever. The disease progressed rapidly and septic shock symptoms developed. Laboratory tests indicated progressively decreased white blood cells and platelets, as well as significant increases in certain inflammation indicators. The effect of treatment with Tazocin was good. The growth period of R. mannitolilytica in sterile distilled water was > 6 months. The pulsed-field gel electrophoresis (PFGE) results revealed that the infectious strains from these 3 patients were not the same clonal strain. This bacterium was not detected in the nosocomial infection samples.
CONCLUSIONS
Our results suggest that R. mannitolilytica-induced septicemia had an acute disease onset and rapid progression. The preferred empirical antibiotic was Tazocin. In these 3 cases, the R. mannitolilytica-induced septicemia was not due to clonal transmission.
PubMed: 27679705
DOI: 10.5812/jjm.34373 -
Access Microbiology Aug 2022is a rare opportunistic pathogen capable of causing a serious infection in immunocompromised patients. Our objective was to describe all cases of bloodstream infection...
INTRODUCTION
is a rare opportunistic pathogen capable of causing a serious infection in immunocompromised patients. Our objective was to describe all cases of 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 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 . After 48 h of incubation, no 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
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. is resistant to many routinely used antibiotics, including carbapenems.
PubMed: 36003352
DOI: 10.1099/acmi.0.000367 -
Le Infezioni in Medicina Dec 2018Ralstonia mannitolilytica is a difficult-to-diagnose, aerobic, Gram-negative bacillus, mainly causing healthcare infections in immunocompromised hosts. We report the... (Review)
Review
Ralstonia mannitolilytica is a difficult-to-diagnose, aerobic, Gram-negative bacillus, mainly causing healthcare infections in immunocompromised hosts. We report the first case of R. mannitolilytica bacteraemia in a kidney transplant recipient. Identification of R. mannitolilytica was finally performed by 16S rRNA gene sequencing. All cases of R. mannitolilytica bacteraemia reported in the English language literature over the past 20 years are reviewed to alert clinicians to the epidemiological, clinical, diagnostic, prognostic and microbiologic features of this emerging pathogen.
Topics: Adult; Bacteremia; Gram-Negative Bacterial Infections; Humans; Male; Ralstonia
PubMed: 30555144
DOI: No ID Found -
Zhejiang Da Xue Xue Bao. Yi Xue Ban =... Jul 2017To investigate the drug resistance, β-lactamase-encoding genes and protoporphyrin ferrochelatase-encoding genes of , and to explore its structure and pathogenic function.
OBJECTIVE
To investigate the drug resistance, β-lactamase-encoding genes and protoporphyrin ferrochelatase-encoding genes of , and to explore its structure and pathogenic function.
METHODS
The strain was isolated by plate streaking method and identified by automatic bacteria detection system and 16S RNA gene PCR. Microdilution method was applied for drug susceptibility test. β-lactamases, extended spectrum β-lactamases (ESBL) and carbapenemases were detected using nitrocefin-disk, Kirby-Bauer disk, and Hodge test, respectively. Five β-lactamase-encoding genes and protoporphyrin ferrochelatase-encoding gene of the isolate were amplified by PCR for sequencing. Bioinformatic softwares were used to analyze the structure and function of the product of protoporphyrin ferrochelatase-encoding gene.
RESULTS
A strain belonging to was isolated. This isolate was sensitive to cefepime, ciprofloxacin, ofloxacin and tigecycline, but resistant to five penicillins, four cephalosporins and two carbapenems antibiotics. The isolate produced β-lactamases but did not produce ESBL and carbapenemases. The isolate had five distinct β-lactamase-encoding genes and protoporphyrin ferrochelatase-encoding gene. The product of protoporphyrin ferrochelatase-encoding gene contained two functional domains of protoporphyrin ferrochelatase belonging to type Ⅱ chelatase superfamily that presented the most closely genetic relationship with the protoporphyrin ferrochelatase of .
CONCLUSIONS
The isolate of has a higher resistance to β-lactam antibiotics and its β-lactamase-encoding genes are different with the common bacterial β-lactamase-encoding genes. Protoporphyrin ferrochelatase may act as an important virulence factor of .
Topics: Anti-Bacterial Agents; Drug Resistance; Ferrochelatase; Protoporphyrins; Ralstonia; beta-Lactamases
PubMed: 29256231
DOI: 10.3785/j.issn.1008-9292.2017.08.11 -
Cureus Apr 2022spp. are non-fermenting aerobic gram-negative rods found in humid environments, whose role as opportunistic human pathogens has lately been recognized. is one of the...
spp. are non-fermenting aerobic gram-negative rods found in humid environments, whose role as opportunistic human pathogens has lately been recognized. is one of the three members of the genus (together with and ). Bone infections by spp. are very rare. We report a case of femoral osteomyelitis caused by . Among literature search, only eight cases of bone infection due to the genus have been described, in all of which the causative agent was identified as . To our knowledge, this is the first reported case of osteomyelitis attributed to . Despite its low virulence, has specific characteristics that promote its spread and shows high antibiotic resistance, partly due to its ability to create a biofilm. Identification of spp. poses unique difficulties as the distinction between the species of the genus is not straightforward. Additionally, the bacteria may be misidentified as other closely related species. Recent data suggests that modern spectrometry and gene sequencing techniques are essential to avoid these pitfalls. Susceptibility data about the genus is limited and based on a small number of case reports, therefore there is no standardized antibiotic susceptibility testing and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints exist. The report aims is to provide useful information on the antibiotic selection and treatment suggestions to be followed for bone infections caused by the genus, along with a review on the literature of this emerging opportunistic pathogen.
PubMed: 35586345
DOI: 10.7759/cureus.24151 -
Epidemiology and Infection Oct 2017This study aimed to determine prevalence of Ralstonia spp. in cystic fibrosis patients, look for any evidence of cross infection and to describe clinical outcomes for...
This study aimed to determine prevalence of Ralstonia spp. in cystic fibrosis patients, look for any evidence of cross infection and to describe clinical outcomes for patients infected by Ralstonia spp. Prevalence of Ralstonia spp. was calculated annually from 2008 to 2016. Pulsed-field gel electrophoresis was performed on ⩾1 sample from patients with an isolation of Ralstonia spp. between 2008 and 2016. A prospective, longitudinal observational study of adult patients was performed with 12 months follow-up from recruitment. Prevalence of Ralstonia spp. rose from 0·6% in 2008 to 2·4% in 2016. In total 12 out of 14 (86%) patients with ⩾1 isolation of Ralstonia spp. developed chronic infection. A pair and a group of three unrelated patients with epidemiological connections shared strains of Ralstonia mannitolilytica. Lung function of Ralstonia spp. infected patients was moderately to severely impaired. Prevalence of Ralstonia spp. is low but increasing. The risk of a patient developing chronic Ralstonia spp. infection following first acquisition is high and cross-infection may be possible. Whether Ralstonia spp. infection causes increased pulmonary exacerbation frequency and lung function decline needs to be evaluated in larger prospective studies.
Topics: Adolescent; Adult; Comorbidity; Cross Infection; Cystic Fibrosis; Electrophoresis, Gel, Pulsed-Field; England; Female; Gram-Negative Bacterial Infections; Humans; Longitudinal Studies; Male; Prevalence; Prospective Studies; Ralstonia; Risk; Young Adult
PubMed: 28791938
DOI: 10.1017/S0950268817001728 -
BMC Pulmonary Medicine Jan 2023Spherical pneumonia is an extremely rare condition that is difficult to diagnose. It is a specific type of lung infection that often manifests as a round or round-like... (Review)
Review
BACKGROUND
Spherical pneumonia is an extremely rare condition that is difficult to diagnose. It is a specific type of lung infection that often manifests as a round or round-like mass on chest imaging. Spherical pneumonia is easily misdiagnosed as a pulmonary tumor; therefore, awareness of this disease must be strengthened.
CASE PRESENTATION
The patient was a 29-year-old female who had persistent cough and sputum for approximately 1 month and fever for 5 days. Chest computed tomography (CT) at our hospital revealed a mass in the lower lobe of the right lung near the hilar region, with obstructive pulmonary atelectasis and obstructive pneumonia. Although lung cancer was suspected, Ralstonia mannitolilytica was detected by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid, and no cancer cells or Mycobacterium tuberculosis were detected. Finally, the patient was diagnosed with spherical pneumonia caused by R. mannitolilytica. Anti-infective treatment, symptomatic treatment, and administration of a traditional Chinese medicine decoction were performed based on the syndrome differentiation. After 10 days of treatment, chest CT revealed few lesions in the lower lobe of the right lung, which were significantly reduced compared with those in the past.
CONCLUSIONS
Spherical pneumonia caused by R. mannitolilytica has not yet been reported and differential diagnosis is key in clinical diagnosis. When spherical pneumonia is difficult to diagnose, mNGS may be a better alternative.
Topics: Female; Humans; Adult; Pneumonia; Lung; Ralstonia; Bronchoalveolar Lavage Fluid; Pulmonary Atelectasis; Lung Neoplasms; High-Throughput Nucleotide Sequencing
PubMed: 36647091
DOI: 10.1186/s12890-023-02316-8 -
Antimicrobial Resistance and Infection... 2017, an environmental microorganism, has been occasionally associated with healthcare infections. The aim of this study was to investigate an outbreak caused by in...
BACKGROUND
, an environmental microorganism, has been occasionally associated with healthcare infections. The aim of this study was to investigate an outbreak caused by in oncology patients.
METHODS
Case definition: Oncology outpatients attending a day ward, with positive blood and/or central venous catheter (CVC) culture for spp from September 2013 - June 2014. We analysed medical records, procedures and environmental samples. was identified by 16S rRNA sequencing, and typed by Pulsed Field Gel Electrophoresis (PFGE); resistance to carbapenemes was investigated by phenotypic and molecular methods.
RESULTS
The patients ( = 22) had different malignancies and received different therapy; all had a CVC and 16 patients presented chills and/or fever. was isolated from both blood and CVC ( = 12) or only blood ( = 6) or CVC tips ( = 4). The isolates had indistinguishable PFGE profile, and showed resistance to carbapenems. All the isolates were negative for carbapenemase genes while phenotypic tests suggests the presence of an AmpC β-lactamase activity,responsible for carbapenem resistance. All patients had had CVC flushed with saline to keep the venous access pervious or before receiving chemotherapy at various times before the onset of symptoms. After the first four cases occurred, the multi-dose saline bottles used for CVC flushing were replaced with single-dose vials; environmental samples were negative for
CONCLUSIONS
Although the source of remains unidentified, CVC flushing with contaminated saline solution seems to be the most likely origin of CVC colonization and subsequent infections. In order to prevent similar outbreaks we recommend removal of any CVC that is no longer necessary and the use of single-dose solutions for any parenteral treatment of oncology patients.
PubMed: 28191308
DOI: 10.1186/s13756-017-0178-z -
Infection and Drug Resistance 2019The . genus is a group of non-fermentative, Gram-negative bacteria often resistant to many antibiotics, which are emerging as opportunistic pathogens frequently...
The . genus is a group of non-fermentative, Gram-negative bacteria often resistant to many antibiotics, which are emerging as opportunistic pathogens frequently associated with infections in hospital settings. We present herein a case of combined and persisting and relapsing bacteraemia, possibly caused by a septic arterial thrombosis secondary to the rupture of an internal carotid artery aneurysm. Microbiology studies showed that both isolates produced biofilm and carried class D oxacillinase genes. When confronted with infections caused by members of the genus, identification to the species level is crucial for correct clinical management, as the two species show different antibiotic susceptibility patterns.
PubMed: 31447567
DOI: 10.2147/IDR.S206492