Department of Pediatrics and Neonatology, University General Hospital of Patras, Patras, Greece.
Department of Microbiology, University General Hospital of Patras, Patras, Greece.
Infect Disord Drug Targets. 2021;21(2):168-172. doi: 10.2174/1871526520666200330163504.
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.
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, 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 (endotracheal tube tip cultures) isolated meropenem- and gentamicin-resistant strain of rare pathogen Ralstonia mannitolilytica. Ralstonia spp. are aerobic, Gram-negative, lactose non-fermenting, oxidaseand 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.
We intend to raise awareness among neonatologists with regard to early detection of unusual pathogens, the emergence of antibiotic resistance patterns, and the obligation for adherence to infection control policies.
早产儿由于免疫系统尚未发育完全、接受的干预措施以及有利于革兰氏阳性和革兰氏阴性病原体对抗生素产生多重耐药性的因素协同作用，被认为是新生儿败血症的高风险亚组。
我们报告了一例由罕见病原体引起的早产儿晚发性新生儿败血症病例；一名极低出生体重早产儿在第 4 周时出现严重的临床恶化，表现为嗜睡、发热、苍白、发绀、腹胀、心动过速和呼吸恶化。进行了全面的败血症筛查，开始使用广谱抗生素治疗，并按需提供支持性护理。血培养（气管内管尖端培养）分离出耐美罗培南和庆大霉素的罕见病原体嗜麦芽窄食单胞菌。嗜麦芽窄食单胞菌是需氧、革兰氏阴性、乳糖非发酵、氧化酶和触酶阳性的杆菌，在水和土壤中生长。嗜麦芽窄食单胞菌仅偶尔被鉴定为新生儿败血症的病原体；据我们所知，这是迄今为止文献中第二例由嗜麦芽窄食单胞菌引起的新生儿败血症报告。我们的患者最终根据药敏模式接受了静脉注射环丙沙星治疗，并从感染中恢复良好。
我们希望提高新生儿科医生对早期发现不常见病原体、抗生素耐药模式的出现以及遵守感染控制政策的认识。
