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Antimicrobial Resistance & Infection Control
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Open Access 01-12-2017 | Research

Ralstonia mannitolilytica infections in an oncologic day ward: description of a cluster among high-risk patients

Authors: Claudia Lucarelli, Enea Gino Di Domenico, Luigi Toma, Domenico Bracco, Grazia Prignano, Maria Fortunati, Lorella Pelagalli, Fabrizio Ensoli, Patrizio Pezzotti, Aurora García-Fernández, Annalisa Pantosti, Loredana Ingrosso

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2017

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Abstract

Background

Ralstonia spp, an environmental microorganism, has been occasionally associated with healthcare infections. The aim of this study was to investigate an outbreak caused by Ralstonia mannitolilytica in oncology patients.

Methods

Case definition: Oncology outpatients attending a day ward, with positive blood and/or central venous catheter (CVC) culture for Ralstonia spp from September 2013 – June 2014. We analysed medical records, procedures and environmental samples. R. mannitolilytica 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 (N = 22) had different malignancies and received different therapy; all had a CVC and 16 patients presented chills and/or fever. R. mannitolilytica was isolated from both blood and CVC (n = 12) or only blood (n = 6) or CVC tips (n = 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 R. mannitolilytica.

Conclusions

Although the source of R. mannitolilytica remains unidentified, CVC flushing with contaminated saline solution seems to be the most likely origin of R. mannitolilytica 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.
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Metadata
Title
Ralstonia mannitolilytica infections in an oncologic day ward: description of a cluster among high-risk patients
Authors
Claudia Lucarelli
Enea Gino Di Domenico
Luigi Toma
Domenico Bracco
Grazia Prignano
Maria Fortunati
Lorella Pelagalli
Fabrizio Ensoli
Patrizio Pezzotti
Aurora García-Fernández
Annalisa Pantosti
Loredana Ingrosso
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2017
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-017-0178-z

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