Rare Cases of Ralstonia pickettii Blood Stream Infection in Hospitalized Patients with Uterus and Cervical Cancer Under Surgery and Blood Transfusion: A Case Report

Abstract

Introduction: Ralstonia pickettii is a rare environmental gram-negative bacterium that causes nosocomial infection due to its robust quorum-sensing system and constitution of biofilm in medical equipment and hospital instruments. Objectives: According to various case reports, Ralstonia is associated with catheter-related bacteremia, pneumonia, osteomyelitis, hemoperitoneum infection, meningitis, neonatal sepsis, endocarditis, and peritoneal fluid infection after internal surgery. Methods: In this study, rare cases of nosocomial R. pickettii bloodstream infection were reported in hospitalized patients with uterus and cervical cancer with metastatic squamous cell carcinoma to the colon under surgery and blood transfusion. Results: A 46-year-old woman was admitted to the general surgery department of the target teaching hospital for the chief complaint of abdominal pain, nausea, and vomiting. Before admission, she was under hysterectomy, colectomy, colostomy, and chemotherapy three weeks ago. She received packed red blood cells twice during hospitalization and surgery. In addition, two consecutive blood cultures were positive for R. pickettii using the BD BACTEC™ FX Instruments and confirmation by bioMérieux API 20NE. According to antibiogram test reports, Meropenem (1gr/Q8h/IV) was prescribed, and fortunately, blood culture results were negative after 14 days. In addition, the patient received pantoprazole (I.V. 40 mg) and octreotide (100 mcg/mL) during hospitalization. Conclusions: R. pickettii is responsible for bloodstream infection and sepsis in cancer departments, especially during common surgical operations, and blood transfusions, especially for cancer patients. Hence, recognizing the source of infection can be helpful in appropriate infection control and successful treatment.