Nosocomial bloodstream infection and the emerging carbapenem-resistant pathogen Ralstonia insidiosa
Abstract Background Ralstonia picketti, Ralstonia mannitolilytica, and Ralstonia insidiosa have recently been regarded as emerging pathogens of infectious diseases, in particular as the pathogens responsible for nosocomial infection in immunocompromised patients. R. insidiosa differs from R. pickett...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-019-3985-4 |
| _version_ | 1818285311023644672 |
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| author | Qingqing Fang Yu Feng Ping Feng Xiaohui Wang Zhiyong Zong |
| author_facet | Qingqing Fang Yu Feng Ping Feng Xiaohui Wang Zhiyong Zong |
| author_sort | Qingqing Fang |
| collection | DOAJ |
| description | Abstract Background Ralstonia picketti, Ralstonia mannitolilytica, and Ralstonia insidiosa have recently been regarded as emerging pathogens of infectious diseases, in particular as the pathogens responsible for nosocomial infection in immunocompromised patients. R. insidiosa differs from R. picketti and R. mannitolilytica, and its related infections are rarely reported. Methods Clinical data from two nosocomial bloodstream infection cases were extracted and analyzed. The causable isolates were identified by the VITEK 2 Compact system, matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and molecular identification methods using PCR with universal and species-specific primers. Antimicrobial susceptibility testing was performed using the broth microdilution method. Both of the isolates were subjected to whole genome sequencing using a HiSeq X10 Sequencer. Antimicrobial resistance genes, virulence factors, and plasmid replicons were identified from assembled genomes. A real-time RT-PCR experiment and a cloning experiment were conducted to explore the related class D β-lactamase-encoding genes. Results Both patients recovered under therapy with antibiotics. Isolates were initially misidentified as R. mannitolilytica by the VITEK 2 Compact system rather than R. insidiosa, as identified by both MALDI-TOF MS and 16S rRNA gene sequencing. Both isolates were resistant to aminoglycosides, β-lactams, and polymyxin B. One isolate harboring bla OXA-570 was resistant to carbapenems. The whole genome sequencing data confirmed species identification based on average nucleotide identity (ANI) and revealed two variants of class D β-lactamase-encoding gene bla OXA (bla OXA-573 and bla OXA-574). The real-time RT-PCR experiment showed no difference in gene expression between bla OXA-570 and bla OXA-573 in our strains. The cloning experiment showed that variant OXA-573 had no carbapenem hydrolase activity. Conclusions We described two cases of nosocomial bloodstream infection caused by R. insidiosa strains. MALDI-TOF MS was cost-effective for rapid species identification. Clinicians should be aware that R. insidiosa can be resistant to commonly used antibiotics, even carbapenems. |
| first_indexed | 2024-12-13T01:06:41Z |
| format | Article |
| id | doaj.art-ae74996b3f534ab497b7fb8393182494 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-13T01:06:41Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-ae74996b3f534ab497b7fb83931824942022-12-22T00:04:32ZengBMCBMC Infectious Diseases1471-23342019-04-011911910.1186/s12879-019-3985-4Nosocomial bloodstream infection and the emerging carbapenem-resistant pathogen Ralstonia insidiosaQingqing Fang0Yu Feng1Ping Feng2Xiaohui Wang3Zhiyong Zong4Center of Infectious Diseases, West China Hospital, Sichuan UniversityCenter of Infectious Diseases, West China Hospital, Sichuan UniversityCenter of Infectious Diseases, West China Hospital, Sichuan UniversityCenter of Infectious Diseases, West China Hospital, Sichuan UniversityCenter of Infectious Diseases, West China Hospital, Sichuan UniversityAbstract Background Ralstonia picketti, Ralstonia mannitolilytica, and Ralstonia insidiosa have recently been regarded as emerging pathogens of infectious diseases, in particular as the pathogens responsible for nosocomial infection in immunocompromised patients. R. insidiosa differs from R. picketti and R. mannitolilytica, and its related infections are rarely reported. Methods Clinical data from two nosocomial bloodstream infection cases were extracted and analyzed. The causable isolates were identified by the VITEK 2 Compact system, matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and molecular identification methods using PCR with universal and species-specific primers. Antimicrobial susceptibility testing was performed using the broth microdilution method. Both of the isolates were subjected to whole genome sequencing using a HiSeq X10 Sequencer. Antimicrobial resistance genes, virulence factors, and plasmid replicons were identified from assembled genomes. A real-time RT-PCR experiment and a cloning experiment were conducted to explore the related class D β-lactamase-encoding genes. Results Both patients recovered under therapy with antibiotics. Isolates were initially misidentified as R. mannitolilytica by the VITEK 2 Compact system rather than R. insidiosa, as identified by both MALDI-TOF MS and 16S rRNA gene sequencing. Both isolates were resistant to aminoglycosides, β-lactams, and polymyxin B. One isolate harboring bla OXA-570 was resistant to carbapenems. The whole genome sequencing data confirmed species identification based on average nucleotide identity (ANI) and revealed two variants of class D β-lactamase-encoding gene bla OXA (bla OXA-573 and bla OXA-574). The real-time RT-PCR experiment showed no difference in gene expression between bla OXA-570 and bla OXA-573 in our strains. The cloning experiment showed that variant OXA-573 had no carbapenem hydrolase activity. Conclusions We described two cases of nosocomial bloodstream infection caused by R. insidiosa strains. MALDI-TOF MS was cost-effective for rapid species identification. Clinicians should be aware that R. insidiosa can be resistant to commonly used antibiotics, even carbapenems.http://link.springer.com/article/10.1186/s12879-019-3985-4Ralstonia insidiosaCarbapenem-resistantBloodstream infectionsNosocomial infectionWhole genome sequencing |
| spellingShingle | Qingqing Fang Yu Feng Ping Feng Xiaohui Wang Zhiyong Zong Nosocomial bloodstream infection and the emerging carbapenem-resistant pathogen Ralstonia insidiosa BMC Infectious Diseases Ralstonia insidiosa Carbapenem-resistant Bloodstream infections Nosocomial infection Whole genome sequencing |
| title | Nosocomial bloodstream infection and the emerging carbapenem-resistant pathogen Ralstonia insidiosa |
| title_full | Nosocomial bloodstream infection and the emerging carbapenem-resistant pathogen Ralstonia insidiosa |
| title_fullStr | Nosocomial bloodstream infection and the emerging carbapenem-resistant pathogen Ralstonia insidiosa |
| title_full_unstemmed | Nosocomial bloodstream infection and the emerging carbapenem-resistant pathogen Ralstonia insidiosa |
| title_short | Nosocomial bloodstream infection and the emerging carbapenem-resistant pathogen Ralstonia insidiosa |
| title_sort | nosocomial bloodstream infection and the emerging carbapenem resistant pathogen ralstonia insidiosa |
| topic | Ralstonia insidiosa Carbapenem-resistant Bloodstream infections Nosocomial infection Whole genome sequencing |
| url | http://link.springer.com/article/10.1186/s12879-019-3985-4 |
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