Ralstonia mannitolilytica septicaemia, an added burden in cancer care: Recognizing the unrecognized

Abstract

Background: Ralstonia mannitolilytica is an often underrecognized pathogen, that can cause infections in immunocompromised hosts. The propensity to form biofilms makes it particularly likely to cause catheter related infections, which is used with increasing frequency in cancer patients. In this study we report on an outbreak of Ralstonia septicaemia at our facility. Aim: To characterize an outbreak of Ralstonia infections at a tertiary care facility with a focus on the antibiotic sensitivity and added burden on treatment. Design: A retrospective analysis of an outbreak of sepsis attributed to Ralstonia mannitolilytica. Methods: We report on nine cases of proven Ralstonia mannitolilytica septicaemia in the period from January 2022 to June 2023. Results: Blood cultures were positive in 66.7%, and three had tip cultures positive . 77.8% of the patients required removal of their central venous access, due to hemodynamic compromise and/or persistent fever despite adequate coverage with empirical antibiotics. 85.7% required reinsertion of PICC lines. Eight of the isolates (88.9%) were resistant to Meropenem, and seven were resistant to Piperacilin + Tazobactam (77.8%). Resistance to Ceftazidime was seen in six isolates, Sensitivity to Cefaperazone + Sulbactam and Levolfloxacin was seen in seven and six patients respectively. Conclusion: Ralstonia mannitolilytica is an emerging pathogen, that can cause significant additional burden in terms of hospitalization and infectious complications in cancer patients with CVC access. There needs to be strict infection control measures in place, for prevention and early recognition.