Ralstonia Mannitolilytica Research Articles

Ralstonia Mannitolilytica Induced Septicemia in a Patient with Pulmonary Edema-A Rare Case Report

Ralstonia Mannitolilytica Induced Septicemia in a Patient with Pulmonary Edema-A Rare Case Report

In-depth comparative pathogenome, virulome, and resistome analysis of an extensive drug resistant Ralstonia mannitolilytica strain isolated from blood

IntroductionRalstonia mannitolilytica is an global opportunistic pathogen responsible for various diseases. In this study, we reported the genome of a R. mannitolilytica isolate responsible for bacteremia in an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsBacterial identification was performed with a Vitek2™ Automated System and 16S rRNA sequencing with BLASTn against the Non-Redundant Protein Sequence (Nr) database. Genome sequencing and analysis were performed using PacBio RS II sequencer, Hierarchical Genome Assembly Process assembly, as well as multiple annotation databases to better understand the innate features. Antibiotic resistance genes and virulence factors were specifically identified through Antibiotic Resistance Genes database and Virulence Factors of Pathogenic Bacteria databases. ResultsThe complete genome sequence was assembled into two chromosomes with 3,495,817 bp and 1,342,871 bp in length and GC% of 65.37 % and 66.43 %, respectively. The two chromosomes were fully annotated. In chromosome 1 and 2, 19 and 14 antibiotic resistant genes and 48 and 55 virulence factors were predicted, respectively. Specifically, beta-lactam resistance genes blaOXA-443, blaOXA-444 were acquired. ConclusionsThis study aids in the understanding of the innate features of R. mannitolilytica in AECOPD.

Ralstonia mannitolilytica infection in a tertiary care centre: an outbreak report

BackgroundIn this paper we describe an outbreak of Ralstonia mannitolilytica infection declared in our facility between January 2021 and January 2022. MethodsIn order to identify the source of the outbreak, we applied widespread epidemiological investigation and infection control measures, including device isolation, environmental sampling, and PFGE typing. ResultsThirty-six cases of R. mannitolilytica infection were identified, mostly adults (78%) and males (75%). Initially, neurological procedures were a common risk factor among cases, leading to sampling of related environmental settings. Cases with other medical procedures started to be reported. The PFGE results showed most R. mannitolilytica isolates were indistinguishable which expanded our investigation to all hospital areas. The infection source was discovered later as a single lot number of sodium chloride solution that had been used in practice. The contaminated solution was recalled from all hospital units and the findings were reported to the Saudi FDA to communicate with the manufacturer and other healthcare organizations involved. No new cases of R. mannitolilytica were identified thereafter. ConclusionOur findings indicate that identifying the source of an outbreak could be challenging. An extended incubation period might be considered to improve and accelerate the identification of R. mannitolilytica. In order to minimize similar incidents, it is essential to regularly monitor the compliance of manufacturers and suppliers with regulations related to the safety of solutions administered in medical practice.

Ralstonia mannitolilytica Infections: A Systematic Review of Case Reports Unveiling Clinical Patterns and Therapeutic Insights.

Ralstonia mannitolilytica is an emerging opportunistic pathogen that has been increasingly reported in clinical settings. Despite its low pathogenicity in immunocompetent individuals, it poses a significant threat to immunocompromised patients, particularly those with underlying medical conditions or invasive medical interventions. This study aimed to evaluate the clinical impact and management strategies based on the analysis of individual case reports on Ralstonia mannitolilytica . A comprehensive search of PubMed was conducted from inception until July 31, 2023, using the terms "Ralstonia mannitolilytica" and/or "Pseudomonas thomasii". Inclusion criteria for our systematic review included human-centered case reports of Ralstonia mannitolilytica infections, excluding case series and review articles. Data extraction followed PRISMA guidelines, including study details and patient characteristics. Case reports were systematically assessed using the JBI critical appraisal checklist, evaluating patient demographics, clinical history, diagnostic methods, interventions, post-intervention outcomes, adverse events, and lessons learned to minimize bias risk. A total of 17 case reports of Ralstonia mannitolilytica infections were included in our systematic review. Studies published from 2001 to 2023 revealed diverse global contributions, with 29.41% from China. Infection origins varied, with catheter-related cases being predominant. Mortality was reported in two studies. Antibiotic sensitivity analysis showed sensitivity to third-generation cephalosporins, notably Ceftazidime. Quality appraisal revealed that all studies had a low risk of bias, ensuring the overall robustness of the case reports. This study emphasizes the importance of understanding Ralstonia mannitolilytica infections, given their varied clinical presentations and antibiotic responses. The study also underscores the necessity for precise identification, customized treatments, and ongoing research to manage these infections effectively.

Phenotypic and genetic characterization of a lipolytic Ralstonia mannitolilytica isolate from petroleum-contaminated soil in Iraq.

Lipases play a crucial role in various industrial applications, and microbial lipases, particularly those from bacteria, possess significant properties. With increasing concerns about the environmental and health impacts of hydrocarbons from pipelines and refineries, there is a growing need to mitigate the risks associated with these compounds. In this study, 40 bacterial isolates were recovered from contaminated soil samples collected from multiple refineries across Iraq. Using the Vitek system, bacterial isolates were identified up to the species level, revealing that only 12 isolates exhibited lipase-producing capabilities. Among the lipase-producing isolates, Ralstonia mannitolilytica demonstrated the highest extracellular lipase activity, as determined by an olive oil plate assay supplemented with rhodamine B. Confirmation of the species identity was achieved through 16S rRNA gene sequencing, with the obtained sequence deposited under accession number LC772176.1. Further sequence analysis revealed single nucleotide polymorphisms (SNPs) in the genome of Ralstonia mannitolilytica strain H230303-10_N19_7x_R2 (CP011257.1, positions 1,311,102 and 1,311,457). Additionally, the presence of the lipase gene was confirmed through amplification and sequencing using a thermocycler PCR. Sequence analysis of the gene, aligned using Geneious Prime software, identified SNPs (CP010799, CP049132, AY364601, CP011257, and CP023537), and a phylogenetic tree was constructed based on genetic characterization. Our findings highlight the potential of Ralstonia mannitolilytica as a promising candidate for lipase production and contribute to our understanding of its genetic diversity and biotechnological applications in hydrocarbon degradation and industrial processes.

Complete sequence of carbapenem-resistant Ralstonia mannitolilytica clinical isolate co-producing novel class D β-lactamase OXA-1176 and OXA-1177 in Japan.

In 2020, the Ralstonia mannitolilytica strain JARB-RN-0044 was isolated from a midstream urine sample of an elderly hospitalized patient in Japan and was highly resistant to carbapenem (i.e., imipenem, meropenem, and doripenem). Whole-genome sequencing revealed that the complete genome consists of two replicons, a 3.5-Mb chromosome and a 1.5-Mb large non-chromosomal replicon which has not been reported in R. mannitolilytica, and referred to as the "megaplasmid" in this study based on Cluster of Orthologous Group of proteins functional analysis. The strain JARB-RN-0044 harbored two novel OXA-60 and OXA-22 family class D β-lactamase genes blaOXA-1176 and blaOXA-1177 on the megaplasmid. Cloning experiments indicated that Escherichia coli recombinant clone expressing blaOXA-1176 gene showed increased minimum inhibitory concentrations (MICs) of imipenem, meropenem, and doripenem, indicating that blaOXA-1176 gene encodes carbapenemase. In contrast, E. coli recombinant clone expressing blaOXA-1177 gene showed increased MICs of piperacillin and cefazolin, but not of carbapenem. Interestingly, the 44.6 kb putative prophage region containing genes encoding phage integrase, terminase, head and tail protein was identified in the downstream region of blaOXA-1176 gene, and comparative analysis with some previously reported R. mannitolilytica isolates revealed that the prophage region was unique to strain JARB-RN-0044. The existence of a highly carbapenem-resistant R. mannitolilytica isolate may raise human health concerns in Japan, where the population is rapidly aging.IMPORTANCERalstonia mannitolilytica is an aerobic non-fermenting Gram-negative rod commonly found in aquatic environments and soil. The bacteria can occasionally cause severe hospital-acquired bloodstream infections in immunocompromised patients and it has been recently recognized as an emerging opportunistic human pathogen. Furthermore, some R. mannitolilytica isolates are resistant to various antimicrobial agents, including β-lactams and aminoglycosides, making antimicrobial therapy challenging and clinically problematic. However, clinical awareness of this pathogen is limited. To our knowledge, in Japan, there has been only one report of a carbapenem-resistant R. mannitolilytica clinical isolate from urine by Suzuki et al. in 2015. In this study, whole-genome sequencing analysis revealed the presence and genetic context of novel blaOXA-1176 and blaOXA-1177 genes on the 1.5 Mb megaplasmid from highly carbapenem-resistant R. mannitolilytica isolate and characterized the overall distribution of functional genes in the chromosome and megaplasmid. Our findings highlight the importance of further attention to R. mannitolilytica isolate in clinical settings.

New Bioremediation by Lipase Purified from Ralstonia mannitolilytica for Petroleum Hydrocarbons

A growing issue of contaminated soil caused by oil derivers in Iraq, requires detection of new methods for bioremediation. The present work aims to purify of extracellular lipase enzyme that can eliminate oil derivers. Seven strains of lipolytic bacteria were collected from Al- Dora electricity station soil Baghdad/ Iraq that polluted with oil derivers. Ralstonia mannitolilytica considered higher ability in lipolytic enzymes production. Crude lipase activity gave (1.66 U/ml). The purification procedure resulted in 8.9 fold with a 23.2% final yield. The purity of lipase and molecular weight confirmed by SDS-PAGE. The efficiency of ten aliphatic hydrocarbon compounds in the soil contaminated with diesel decreases after treatment with purified enzyme (7.6 U/ml) for 24 hr. at natural environment to mimic the nature compared with control. The results concluded the degradation of aliphatic hydrocarbon compounds by lipase enzyme that purified from local Ralstonia mannitolilytica isolates was an efficient (biological) treatment. Although there are studies related to bioremediation used different bacterial isolates types and enzymes such as Pseudomonas sp. none of it used Ralstonia mannitolilytica isolate and lipase enzyme as bioremediation of oil spills.

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

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.

An Outbreak of Ralstonia mannitolilytica Septicaemia at a Tertiary Care Hospital: An Observational Cross-sectional Study

Introduction: Ralstonia spp. is an emerging non fermenting Gram negative bacillus implicated in cases of bloodstream infections in immunocompromised individuals. It is commonly found as an environmental contaminant in hospital settings. Several sporadic outbreaks have been reported from different parts of the world due to Ralstonia spp. This study reports a similar outbreak at a tertiary care hospital in Northern India. Aim: To determine the source of Ralstonia septicaemia in affected patients at a tertiary care centre. Materials and Methods: The present observational crosssectional study was conducted at the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India from February 2020 until the end of March 2020 (two months). A total of 2,650 blood cultures were received during the study period; of these, 53 (2%) patients were found to have Ralstonia mannitolilytica infection over a two month period. All patients from various wards whose blood cultures showed growth of Ralstonia species were included in this study. The organism was identified using both biochemical tests and Matrix-Assisted Laser Desorption Ionisation-Time of Flight Mass Spectrometry (MALDI-TOF MS). Antibiotic sensitivity testing was conducted using the Kirby-Bauer disk diffusion assay. Environmental surveillance was conducted to detect the source of origin. Patients’ age, sex, duration of hospital stay, co-morbidities, and other clinical parameters were recorded. Statistical analysis was performed using Microsoft Excel. Results: There were 52 cases of septicaemia due to Ralstonia mannitolilytica, and one Ralstonia isolate was obtained from intraoperative pus. Most of the Ralstonia isolates obtained were Multidrug-Resistant (MDR), showing resistance to imipenem, meropenem, amikacin, aztreonam, and sensitivity to first-line drugs such as ceftazidime, piperacillin-tazobactam, cefoperazone-sulbactam, levofloxacin, and trimethoprimsulfamethoxazole, resulting in successful treatment. Out of 53 cases, one patient succumbed to death due to surgical complications. Environmental sampling did not yield any organisms resembling Ralstonia spp. Conclusion: The environmental source of the Ralstonia bacteraemia outbreak could not be identified in this study. All patients except one were successfully treated with antibiotics. Clinicians and microbiologists should remain vigilant in case any such case arises to prevent further outbreaks.

Isolation and Molecular Characterization of Phosphate-Solubilizing Bacteria from Root Nodules of Cowpea (Vigna unguiculata) Seeds Planted at Ota, Ogun State, Nigeria

In line with the race to increase worldwide food production to cater to the growing world population, there is a growing interest in exploring the plant growth-promoting attributes of rhizobia. This is in a bid to curb environmental and health damage arising from the use of chemical fertilizers. Hence, the objective of this work was to isolate and characterize phosphate-solubilizing bacteria from root nodules of cowpea (Vigna unguiculata) seeds planted at Ota, Ogun State, Nigeria using standard techniques. The 16S rRNA gene amplification and sequencing of the organisms identified the 2 isolates which were positive for phosphate solubilization as Pseudomonas straminea and Ralstonia mannitolilytica. Their sequences were deposited to GenBank with the assession numbers MK590690 and MK590695 respectively. Isolate Pseudomonas straminea was more efficient and produced a halo zone (16mm) with a phosphate solubility index (PSI) of 2.0 while isolate Ralstonia mannitolilytica produced a halo zone (14 mm) with PSI of 1.6 after 7 days of incubation. The results obtained from this study indicate that these organisms could be potential candidates to be used as biofertilizers to improve crop yield.

Decolorization potential of malachite green by Ralstonia mannitolilytica isolated from Indonesian cassava-based fermentedfoodtapai.

Pollution due to textile dye effluent mishandling is hazardous to ecosystems and to the living beings inhabiting them. This can cause retarded photosynthesis, disrupted fish day/night cycles, unbalanced bacterial populations, and decreased oxygen concentration in contaminated water, leading to low habitability. In this study, we aimed to isolate and characterize the microorganisms found in Indonesian cassava-based fermented food tapai starter cultures as a source of potential microbes for the biological remediation of textile dye pollutants. Microorganisms in the tapai starter culture were screened for their decolorization activity via spread-culture inoculation on a solid growth medium supplemented with textile dyes. Isolated microorganisms were selected based on their ability to secrete textile dye-decolorizing extracellular enzymes via increased light penetration after incubation of the cell-free supernatant (CFS) containing extracellular enzymes in textile dye solutions. Isolate JSP1 was the only bacterium capable of producing malachite green (MG)-decolorizing extracellular enzymes, which enabled it to survive and decolorize MG up to 375ppm. Moreover, isolate JSP1 CFS was able to optimally decolorize 75% of MG at 100ppm, but its activity was diminished at concentrations > 350ppm. Colony and cellular morphology, biochemistry, and 16S rRNA tests revealed that the isolate was of Ralstonia mannitolilytica. Therefore, R. mannitolilytica isolate JSP1 may be a potential bioremediation agent for MG.

A urokinase-associated outbreak of Ralstonia mannitolilytica bloodstream infections in haemodialysis patients in north-eastern Italy, January to April 2023.

An outbreak of Ralstonia mannitolilytica bloodstream infections occurred in four hospitals in north-eastern Italy, involving 20 haemodialysis patients with tunnelled central vascular catheter access. We identified as the outbreak source a batch of urokinase vials imported from India contaminated with R. mannitolilytica. Whole genome sequences of the clinical and urokinase strains were highly related, and only urokinase-treated patients were reported with R. mannitolilytica infections (attack rate = 34%; 95% confidence interval: 22.1-47.4). Discontinuation of the contaminated urokinase terminated the outbreak.

The Role of Automation for Early Diagnosis of Non-fermenter Superbugs in Critically Ill Septicemic Hospitalized Patients.

Introduction Non-fermenting Gram-negative bacilli (NFGNB) are emerging superbugs of bloodstream infections (BSI), causing increased mortality in hospitalized patients. NFGNB are challenging to identify using conventional identification techniques. Hence, automation is beneficial for accurate and fast diagnosis; it also facilitates rapid treatment and recovery of patients. This study aims to isolate/identify NFGNB from BSI and determine its antimicrobial susceptibility pattern. Material and methods This study was conducted in the Department of Microbiology, LLRMMC, Meerut, for a period of six months (June to November 2022). The samples were processed using automated blood culture (BD BACTEC) and an identification/sensitivity testing system (BD Phoenix). Results Out of 1340 blood cultures, 347 (25.7%) were flagged positive for microbial growth. A total of 103 (7.6%) NFGNB were isolated, showing their strong association with BSI. The NFGNB isolates were Pseudomonas species 23 (22.3%), Acinetobacter baumannii 19 (18.4%), Salmonella spp. 19 (18.4%), Sphingomonas paucimobilis 17 (16.5%), Aeromonas hydrophila 5 (4.8%), Rhizobium radiobacter sp. 4 (3.8%), Stenotrophomonas maltophila 3 (2.9%), Burkholderia cepacian 3 (2.9%), Proteus mirabilis 2 (1.9%), Achromobacter xylosoxidans 2 (1.9%), Elizabethkingia meningoseptica 2 (1.9%), Ochromobacter anthropic 2 (1.9%), Cuprivadus pauculus 1 (0.9%), and Ralstonia mannitolilytica 1 (0.9%). Conclusions Automation helps in the prompt reporting of NFGNB and their antibiogram pattern by microbiology laboratories, facilitating the early and accurate management of patients with BSI.

Bacterial contamination of water used as thermal transfer fluid in fluid-warming devices

Recent reports implied heater-cooler units (HCU), which are used for warming of infusions, blood or in ECMO devices, as possible origin of healthcare-associated infections (HAIs) with potentially pathogenic bacteria like nontuberculous mycobacteria [1]. This represents a source of contamination in a usually sterile setting. Aim of this study is to analyse water from infusion heating devices (IHDs) for bacterial contamination and to raise the question if IHDs act as a possible source in the transmission of HAIs. 300-500 ml of thermal transfer fluid (TTF) derived from the reservoirs of 22 independent IHDs were collected and processed on different selective and non-selective media for colony count and identification of bacteria. Strains of Mycobacterium species (spp.) were further analysed by whole genome sequencing. Bacterial growth was observed in each of the 22 collected TTFs after cultivation at 22°C and 36°C. Pseudomonas aeruginosa was the most frequent pathogen identified, being present in 13.64% (3/22) at > 100 CFU/100mL. Colonization with Mycobacterium chimaera, Ralstonia pickettii and Ralstonia mannitolilytica was detectable in 9.09% (2/22) of the isolates. Primary sequencing of the detected M. chimaera suggests a close relationship to a M. chimaera strain detected in an outbreak in Switzerland, which led to the death of two patients. A contamination of the TTF represents a germ reservoir in a sensitive setting. Handling errors of the IHD may lead to distribution of opportunistic or facultative bacterial pathogens, increasing the risk of nosocomial infection transmission.

Spherical pneumonia caused by Ralstonia mannitolilytica: a case report and literature review

BackgroundSpherical 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 presentationThe 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.ConclusionsSpherical 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.

Clinical Manifestation of Ralstonia mannitolilytica Infection in Pediatric Patients and Epidemiological Investigation of Outbreaks.

Ralstonia mannitolilytica is a causative organism of nosocomial infections, particularly associated with contaminated water, and resistant to various antibiotics, including carbapenems. Several clusters of R. mannitolilytica infections appeared in children at our institute from August 2018 to November 2019. From March 2009 to March 2023, all patients admitted to Asan Medical Center Children's Hospital in Seoul, Korea, with culture-confirmed R. mannitolilytica and corresponding clinical signs of infection were identified. Epidemiological and environmental investigations were conducted. Polymerase chain reaction (PCR) was performed for the genes of OXA-443 and OXA-444 on R. mannitolilytica isolates. A total of 18 patients with R. mannitolilytica 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 R. mannitolilytica 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 R. mannitolilytica isolates had positive PCR results for OXA-443 and OXA-444 genes, there were no significant differences in antimicrobial susceptibility patterns. Environmental sampling identified R. mannitolylica 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 R. mannitolilytica infection cases have been reported since December 2019. R. mannitolilytica can cause life-threatening infections with high mortality in fragile pediatric populations. To prevent outbreaks, healthcare workers should be aware of R. mannitolilytica infections and strive to comply with infection control policies.

Quantitative and qualitative characterization of commercially available oral suspension of probiotic products containing Bacillus Clausii spores

Probiotics contain beneficial live bacteria that confer several health benefits to the host. For the past 50 years, spore-forming Bacillus species have been used in the form of probiotics. Among these, Bacillus clausii strains are used for the management of acute and antibiotic-associated diarrhoea. In the present work, we have evaluated the asserted label information on randomly chosen commercial Bacillus clausii spore suspension of probiotic products. The quality and number of viable bacteria were evaluated based on the colony count, antibiotic resistance, and hemolytic activity assays. The colony fingerprinting and 16S rRNA gene-sequencing techniques were used to confirm the presence of a univariate strain (Bacillus clausii). Our results corroborated the label count of 2 × 109 CFU/5 mL in BACIPRO®, ENTEROGERMINA®, and TUFPRO® products. However, vegetative spore count was not found to match with the given label count in BENEGUT®, PROALANA-B®, β-LOCK®, and PROCILLUS® Bacillus clausii brands. In the hemolytic activity assay, except for β-LOCK®, the other 6 products showed gamma-hemolysis activity. Bacillus clausii isolated from all 7 probiotic products demonstrated resistance to several broad-spectrum antibiotics. The 16S rRNA gene-sequencing data detected genera of Bacillus and Bacillus clausii strain in the BACIPRO®, ENTEROGERMINA®, PROALANA-B®, BENEGUT®, and TUFPRO® products; however, Ralstonia mannitolilytica and Paenibacillus dendritiformis species were identified in β-LOCK® and PROCILLUS®, respectively. As correct label information was observed only in BACIPRO®, ENTEROGERMINA®, and TUFPRO® products, it is proposed that a more stringent quality check would minimize the possibility of mismatch concerning the label information.

Outbreak of Ralstonia mannitolilytica Infection in Hemato-Oncology Unit: Case Series and Review of Literature

AbstractRalstonia mannitolilytica is a Gram-negative, nonfermentative, soil bacterium that is reported to cause opportunistic infections in immunocompromised patients in nosocomial settings. After extensive review of literature, it was found that this is second outbreak reported from India. This study is a retrospective analysis of the clinical features, outcome, and source identification of R. mannitolilytica infection outbreak in a hemato-oncology unit of a tertiary care center of North India between February 2020 and March 2020. We report an outbreak of R. mannitolilytica bacteremia (with or without septic shock) in five patients admitted in hemato-oncology unit at a tertiary care institute in North India for 1 month period. Four patients were cured after administration of appropriate antibiotics as per sensitivity reports, while one patient died of septicemia due to delayed diagnosis. Environmental cultures revealed multidose saline bottles used for administration of drugs as the source of outbreak. Following implementation of use of single dose diluents and flushing solutions in patients with central venous catheter, no new case was reported. Clinicians and microbiologists should keep high index of suspicion to identify these organisms as timely diagnosis is the only key to improve outcomes.

Ralstonia mannitolilytica Bacteremia in an Immunocompromised Patient: Case Report and Review

Ralstonia mannitolilytica is an emerging opportunist pathogen reported in many healthcare facilities over the years. We report a case with R. mannitolilytica bacteraemia in breast carcinoma patient with chemo port. Identification of this non fermentative, Gram negative bacilli was done by Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry (MALDI TOF MS). A minireview of cases of R. mannitolilytica bacteremia in the recent years with special reference to those reported in India is done.

Ralstonia mannitolilytica Bacteremia in an Immunocompromised Patient: Case Report and Review

Ralstonia mannitolilytica Bacteremia in an Immunocompromised Patient: Case Report and Review