Ralstonia mannitolilytica, an unusual pathogen in the Neonatal Intensive Care Unit: a case of neonatal sepsis and literature review.

BACKGROUND: Premature infants are considered high-risk subgroup for neonatal sepsis due to yet defective immune system, interventions practised and synergy of factors favoring multiple resistance of Gram-positive and Gram-negative pathogens to antimicrobial agents. CASE PRESENTATION: We present a case of late-onset neonatal sepsis in a premature infant caused by an uncommon pathogen; a premature infant of extremely low birth weight had in his 4th week of life severe clinical deterioration with lethargy, fever, pallor, 1 mottling, abdominal distention, tachycardia, and worsening respiratory impairment. Full septic screen was performed, broad-spectrum antibiotic therapy was initiated and supportive care per needs was provided. Blood cultures (and endotracheal tube tip cultures) isolated meropenem- and gentamicin-resistant strain of rare pathogen Ralstonia mannitolilytica. Ralstonia spp are aerobic, Gram-negative, lactose nonfermenting, oxidase- and catalase-positive bacilli, thriving in water and soil. Ralstonia spp are identified only sporadically as causative agents of neonatal sepsis; to our knowledge this is the second report of neonatal sepsis due to R. mannitolilytica in the literature so far. Our patient was eventually treated (per sensitivity pattern) with intravenous ciprofloxacin, and recovered well from the infection. CONCLUSION: We intend to raise awareness among neonatologists with regards to early detection of unusual pathogens, emergence of antibiotic resistance patterns, and obligation for adherence to infection control policies.