RESUMO
Ralstonia pickettii is a rare Gram-negative opportunistic bacterium that causes rare infections such as bacteremia, neonatal sepsis, endocarditis, and meningitis in hospitalized or immunocompromised patients. In this study, we identified and reported bloodstream infection caused by R. pickettii in a 15 -year-old boy patient with an autoimmune disease, Guillain-Barré syndrome, under plasmapheresis and intravenous immune globulin (IVIG) therapy. He was referred for admission to the neurology center of the teaching hospital of Shiraz, Iran for inability to walk, and lower extremity muscle weakness. After he was treated with plasmapheresis once during hospitalization, and after severe fever besides shivering blood cultures using BACT/ALERT®3D instrument were positive for R. pickettii.According to antibiotic susceptibility test reports, Ciprofloxacin (5 µg) was prescribed. Fortunately, after starting antibiotic treatment, blood culture results reported no growth after 5 days. Indeed, the patient was infected with nosocomial hepatitis A and URSOBIL (300 mg/BID/Po) was administered. Hence, after reporting the infection occurrence to the hospital infection control unit, initial and possible measures such as device infection control, replacement of potentially polluted plasmapheresis fluids, disinfecting the environment and replacing old sterile washing water with new sources were carried out in plasmapheresis unit. In conclusion, R. pickettii is a rare nosocomial infection that is responsible for the contamination of medical equipment, especially in hemodialysis, plasmapheresis devices and sterile solutions. Also, it is suggested that the role and importance of rare environmental bacteria as the causative agents of human infections should not be ignored in medical centers.
RESUMO
Introduction. One of the most important resistant mechanisms in Gram-negative bacteria is extended spectrum ß-lactamases (ESBLs). Harbour-related genes on plasmids, increase the risk of resistance transmission among commonly reported hospital infections.Aim. This study was designed to explore the dissemination of Pseudomonas aeruginosa producing ESBLs on their plasmids recovered from the different wards of Amir-Al-Momenin burn center, Affiliated with Shiraz University of Medical Sciences.Methodology. Among 256 isolates, 88 (34.38 %) P. aeruginosa strains were isolated from burn hospitalized patients. Samples were processed for antibiotic resistance using the Kirby-Bauer method while MIC was performed for colistin. MIC was used by the microdilution broth method as recommended by Clinical and Laboratory Standards Institute guidelines. Related studied genes were evaluated on extracted plasmids by the PCR method.Results. According to the phenotypic and molecular steps, a total of 58 (65.91 %) and 74 (84.10 %) strains detected positive ESBLs, respectively. Based on antibiogram tests, a total of 63 (71.59 %) isolates were detected as multidrug resistant. All ESBL P. aeruginosa isolates showed identical antimicrobial susceptibility profiles. The genotypic prevalence of ESBLs for bla SHV, bla TEM, bla GES, bla OXA-10 and bla PSE genes was 47.73, 78.41, 5.58, 3.41, 4.55 %, respectively.Conclusion. All P. aeruginosa strains producing ESBLs had plasmids containing related genes. The data indicated a high prevalence of ESBL among P. aeruginosa isolates in the southwest of the Iran burn center and their enzyme types were diverse.
