title: Ralstonia mannitolilytica in cystic fibrosis: A new predictor of worse outcomes.
abstract: BACKGROUND
  Patients with Cystic Fibrosis are subject to repeated respiratory tract infections, with recent increasing isolation of unusual pathogens. Ralstonia species have lately been isolated at our institution, an organism historically frequently misidentified as Burkholderia or Pseudomonas. The prevalence of Ralstonia spp. in cystic fibrosis populations has yet to be determined, along with its clinical implications.
  
  
  METHODS
  Seven patients out of the 301 followed at our cystic fibrosis clinic have had Ralstonia strains identified in their respiratory tract. Most strains identified were multi-drug resistant. After aquisition of Ralstonia spp., the patients' clinical course was characterized by more frequent and more severe respiratory infections along with prolonged hospitalizations, greater decline of lung function, and greater mortality. The mortality rate in this group of patients was 86%. No other factor that could explain such a dramatic evolution was identified upon review of patient data. Some of the strains involved were recognized as clones on Pulse Field Electrophoresis Gel, raising the question of person-to-person transmission.
  
  
  CONCLUSIONS
  New pathogens are identified with the evolution of the microbiota in cystic fibrosis respiratory tracts. In our cohort of patients, acquisition of Ralstonia spp. was associated with dramatic outcomes in terms of disease acceleration and raised mortality rates. It is of critical importance to continue to better define the prevalence and clinical impact of Ralstonia in cystic fibrosis populations.
authors.affiliation: Centre hospitalier de l'Université de Montréal (CHUM Hôtel-Dieu), Respiratory Service, 3840 St Urbain St, Montreal, QC, H2W 1T8, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Coman
authors.affiliation: Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), 2725 Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Bilodeau
authors.affiliation: Centre hospitalier de l'Université de Montréal (CHUM Hôtel-Dieu), Respiratory Service, 3840 St Urbain St, Montreal, QC, H2W 1T8, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Lavoie
authors.affiliation: Centre hospitalier de l'Université de Montréal (CHUM Hôtel-Dieu), Respiratory Service, 3840 St Urbain St, Montreal, QC, H2W 1T8, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Carricart
authors.affiliation: Centre hospitalier de l'Université de Montréal (CHUM Hôtel-Dieu), Respiratory Service, 3840 St Urbain St, Montreal, QC, H2W 1T8, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Tremblay
authors.affiliation: University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
authors.forename: J E
authors.initials: JE
authors.lastname: Zlosnik
authors.affiliation: Centre hospitalier de l'Université de Montréal (CHUM Hôtel-Dieu), Respiratory Service, 3840 St Urbain St, Montreal, QC, H2W 1T8, Canada; Institut de recherches cliniques de Montréal (IRCM), 110 Pine Avenue Ouest, Montreal, QC, H2W 1R7, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Berthiaume
keywords: Cystic fibrosis; Mortality; Ralstonia; Respiratory infection