Bloodstream Infections Caused by Drug Resistant Ralstonia species: A Case Series During the COVID-19 Pandemic

Abstract

Ralstonia spp. is an emerging, non-fermentative Gram-negative rod that demonstrates multidrug resistance. Herein, four cases of bloodstream infections (BSI) caused by R. mannitolilytica or R. pickettii are presented. All the cases had comorbidities that predisposed them to this opportunistic infection. The microbiological assessment showed carbapenemase genes carried out in two strains with minimal inhibitory concentrations > 32 μg/mL to imipenem and meropenem. Fluoroquinolones and trimethoprim-sulphamethoxazole were the most potent agents showing activity against 3/4 strains (75%), although treatment should be susceptibility-dependent for each strain. This case series highlights the possibility of co-infection by a rare organism during the COVID-19 pandemic and the importance of the readiness of diagnostic laboratories to support the diagnosis of uncommon pathogens.

Keywords:

• multidrug-resistance
• bacteremia
• bacillary
• OXA-48
• carbapenemase

Ethical Approval

Informed consent to publish was obtained from all cases to publish their cases. No additional approval was needed for these observational, non-interventional case reports. The institution operates in accordance with the 1964 Helsinki declaration and its later amendments.

Acknowledgments

The author would like to thank the four patients of this case series. The author would also like to extend thanks to medical and technical staff members of the institutions, who were involved in the clinical management of the cases.

Disclosure

The author reports no conflicts of interest in this work.

Additional information

Funding

No funding was obtained for this routine diagnostic work.