[A community acquired pneumonia case caused by Ralstonia pickettii].
Ralstonia pickettii, formerly known as Burkholderia pickettii, is a non-fermentative gram-negative bacillus. It is emerging as an opportunistic pathogen both in the hospital setting and in the environment, leading to outbreaks especially in the intensive care units. The available literature revealed two case reports of pneumonia associated with R. pickettii in adults. In this report, a case of pneumoniae due to R. pickettii, in a patient with chronic obstructive pulmonary disease was presented. Fifty-six years old male patient was admitted to the hospital with complaints of shortness of breath, cough, purulent sputum, weakness, fatigue and green colorred diarrhea lacking blood. Lung auscultation revealed decreased respiratory sounds in the right lower lobe. Laboratory findings yielded decreased arterial pH and paO2 and increased pCO2 values, while hemoglobin, hematocrite, blood urea and creatinine levels were increased. Chest X-ray showed an infiltration on right lower zone. The patient was intubated and imipenem 1 x 500 mg/day and netilmicin 1 x 80 mg/day were initiated. Deep tracheal aspirate specimen revealed gram-negative rods and leukocytes, and cultures yielded growth of non-fermentative gram-negative bacilli on blood agar and EMB agar. These bacilli were identified as R. pickettii by using VITEK 2 system (bi-oMerieux Inc, Mercy L'etoil, France). Antibiotic sensitivity test performed by VITEK 2 GP system (bioMerieux Inc, Mercy L'etoil, France) revealed sensitivity to ceftriaxone, imipenem/cilastatin, piperacillin/tazobactam, amikacin, gentamicin, cefoperazone-sulbactam and ciprofloxacin. Treatment with imipenem/cilastatin was continued for 14 days and the patient was completely recovered. This case was presented in order to call attention to R. pickettii as a pathogen that may cause community-acquired lower respiratory tract infection.
Küçükbayrak
Abdulkadir
A
Atatürk GögüUs Hastaliklanr ve Cögus Cerrahisi Egitim ve Araştirma Hastanesi, Enfeksiyon Hastaliklan ve Klinik Mikrobiyoloji Kliniği, Ankara. abdulbayrak@yahoo.com
Uğurman
Feza
F
Dereli
Necla
N
Cizmeci
Zeynep
Z
Günay
Ersin
E
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015377:Cilastatin / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D004338:Drug Combinations; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011480:Protease Inhibitors / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D049920:Ralstonia pickettii / Q000302:isolation & purification*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D011480:Protease Inhibitors; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination