Evaluation of children with ralstonia pickkettii Bacteraemia

Abstract

Objective: Ralstonia pickettii is an opportunistic pathogen that is often considered to be contaminant. It can cause infection due to colonisation in infusion solutions and disinfectants. Although rare, it can lead to nosocomial outbreaks, so this agent should not be ignored. In this study, it was aimed to evaluate the growth of R. pickettii in blood cultures taken in the pediatric wards of our hospital, to analyze the outbreaks by R. pickettii and to discuss the precautions to prevent the outbreaks.Material and Methods: Patients with Ralstonia picketti in blood cultures, who were admitted in the pediatric intensive care unit (PICU; n= 46, 81%), neonatal intensive care unit (n= 7, 12%) and other pediatric wards (n= 4, 7%) between February 2014 and December 2017 were included into the study. Patient's data, the relation between the outbreaks and culture growths, and the sources and the prevention of potential outbreaks were evaluated. Recurrent growths were defined as a single episode.Results: Ralstonia pickettii detected in 57 different specimens in 38 different episodes in a total of 35 patients. Of the fifty-seven blood samples, 67% (n= 38) were peripheral blood cultures, 33% (n= 19) were catheter blood cultures and 74% of the samples lead to infection. Of the 38 ep-isodes, 63% (n= 24) were considered as infection and 37% (n= 14) was contamination. Median age of the patients were seven (0-180) months, and the major underlying comorbidity was congenital heart disease. Of 57 specimens with Raltstonia pickettii growth, 16 (28%) had only R. pickettii growth, and the remaining 41 (71%) cultured growths were poly -microbial. Among these, the most common accompanying microorganisms were Stenotrophomonas maltophilia and Burkholderia species. Of 38 episodes, 58% (n= 22) had a central venous catheter (CVC), of which 64% (n= 14) developed catheter-related bloodstream infection due to R. pickettii. Eighty-one percent of the specimens were detected in the pediatric in-tensive care unit, and the outbreak situation was examined. Twenty-three (61%) of a total of 57 growths were associated with an outbreak of health-care-associated infection in three separate periods. Ralstonia pickettii was not detected in environment scans. Antibiogram features of the growths were similar and they were thought to be of the same isolate, no molecular study was applied. Three patients died within the first 30 days after the growth.Conclusion: Our study has the largest case series reported in a pediatric population in Turkiye and the world. The mortality rate due to R. pickettii was low. Eighty-one percent of the specimens were in the pediatric inten-sive care unit and 61% was associated with the outbreak. The importance of hospital infection control measures in preventing R. pickettii and similar outbreaks were emphasized. A limited number of studies have been conducted on this subject in Turkiye, and we believe that our study will contribute to the literature.