Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Source Investigation and Control of Ralstonia mannitolilytica Bacteremia in a Neonatal Intensive Care Unit: A Case Report

  • Dabin Kim (Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Min Hye Kim (Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Seul Gi Park (Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Sujin Choi (Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Chan Jae Lee (Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Young Hwa Jung (Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Chang Won Choi (Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Myoung-Jin Shin (Infection Control Team, Seoul National University Bundang Hospital) ;
  • Kyoung-Ho Song (Infection Control Team, Seoul National University Bundang Hospital) ;
  • Eu Suk Kim (Infection Control Team, Seoul National University Bundang Hospital) ;
  • Jeong Su Park (Infection Control Team, Seoul National University Bundang Hospital) ;
  • Hong Bin Kim (Infection Control Team, Seoul National University Bundang Hospital) ;
  • Hyunju Lee (Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2023.01.04
  • Accepted : 2023.06.11
  • Published : 2023.07.03
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Abstract

A case of persistent Ralstonia mannitolilytica bacteremia in the neonatal intensive care unit prompted source investigation due to its rarity. After an extensive investigation, a contaminated ultrasonic nebulizer was identified as the source, and the infection was controlled by removing the source. This study emphasizes the importance of further investigations, even in single cases of rare pathogens.

Ralstonia mannitolilytica는 다양한 종류의 상수도에 퍼져 있는 그람 음성세균으로써 병원체로는 흔하지 않지만 골수염, 수막염, 균혈증, 패혈증 등 심각한 결과를 초래하는 기회감염을 일으킬 수 있다. 저자들은 신생아 중환자실에서 발생한 R. mannitolilytica bacteremia 단일사례를보고한다. 재태주수 38주 6일에 2,770 g으로출생한환아는대혈관전위, 심실중격결손, 폐동맥협착이 있어 신생아 중환자실로 입실해 프로스타글란딘E1을 투약 받았으며, 생후 7일부터 간헐적으로 발열이 있어 감염을 배제한 후 체온을 낮추기 위해 가습기를 사용하였다. 생후 34일에 39.2℃의 고열이 있어 시행한 혈액배양 검사에서 R. mannitolilytica가 동정되었다. 이전에 R. mannitolilytica가 기관에서 검출된 적이 없었을뿐더러 항생제 치료에도 균혈증이 지속되어 환경 조사 및 의료기기에 대한 감시 배양를 시행하였다. 환아에게 사용한 가습기에서 R. mannitolilytica가 동정되었고, 가습기 사용을 중단한 후로 균혈증, 발열이 호전되었다. 이 증례는 새로운 또는 흔하지 않은 감염이 있을 경우 감염원에 대한 면밀한 조사가 중요함과 적절한 항생제 치료에도 반응이 없을 경우 환경조사가 필요함을 시사한다.

Keywords

Acknowledgement

The authors would like to thank the members of the infection control team for their support for source investigation and efforts in infection control for this case.

References

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