Ralstonia insidiosa Neonatal Sepsis: A Case Report and Review of the Literature

Introduction Ralstonia spp. are nonfermenting gram-negative bacteria that have recently emerged as opportunistic pathogens. Previously, two case series of infection associated with Ralstonia insidiosa have been published. In this case report, R. insidiosa infection of a neonate in the neonatal intensive care unit (NICU) is presented. Case Presentation A term male infant developed respiratory distress 2 hours after birth and was admitted to the NICU with the presumptive diagnosis of transient tachypnea of the newborn. A left apical pneumothorax was detected, requiring chest tube insertion. An umbilical catheter was placed due to poor peripheral vascular access. On the second day, blood cultures were sent from the umbilical artery and umbilical venous catheters, which showed growth of R. insidiosa. The antibiotics were changed from ampicillin and gentamicin to ampicillin–sulbactam and cefotaxime according to the antibiotic susceptibility test results. Respiratory distress symptoms resolved and the patient was extubated. The infant's clinical condition improved steadily and was discharged with breast feeding and stable vital findings, negative follow-up cultures, and C-reactive protein. Conclusion Ralstonia insidiosa is an emerging pathogen in hospital infections due to its ability to survive in water supplies and sterilized water-based solutions. There is need for vigilance of R. insidiosa, especially in intensive care units. Awareness of rare pathogens, early detection of the bacteria, and antibiotic susceptibility test results are important in the success of treatment.