Abstract:
Background: Ralstonia mannitolilytica is a Gram-negative bacillus belonging to the genus Ralstonia in the family Burkholderiaceae. As an opportunistic pathogen, it is widely distributed in water sources and oligotrophic environments, but cases of catheter-related bloodstream infection (CRBSI) caused by this bacterium are relatively rare. Clinical guidelines recommend catheter removal combined with systemic antibiotic therapy as the standard treatment for CRBSI. However, catheter removal may not be an ideal option for critically ill patients with limited vascular access.
Case presentation: A 47-year-old female with brain death developed CRBSI 14 days after the insertion of a high-pressure resistant double-lumen peripherally inserted central catheter (PICC). Purulent discharge was observed at the puncture site. Blood cultures from peripheral veins and PICC catheter lumens were positive, and multidrug-resistant Ralstonia mannitolilytica was isolated. The strain was sensitive to minocycline and ceftazidime but resistant to other tested antibiotics. Due to extreme difficulty in peripheral venous puncture, the patient’s family refused catheter removal. A multidisciplinary team (MDT) approved the daily application of minocycline ointment under strict procedures. The infection was controlled within 14 days, blood cultures turned negative, the PICC remained functional, and no adverse reactions occurred.
Discussion: Ralstonia mannitolilytica is an opportunistic pathogen with prominent multidrug resistance, and CRBSI caused by it is difficult to treat, especially in patients who cannot undergo catheter removal. Topical minocycline ointment can directly act on the infection site, increase local drug concentration, and effectively control infection without obvious adverse reactions. The successful treatment of this case relied on accurate etiological diagnosis, MDT collaborative management, and standardized topical medication and catheter care.
Conclusion: For patients with multidrug-resistant Ralstonia mannitolilytica-induced CRBSI who cannot undergo catheter removal, topical application of minocycline ointment combined with meticulous catheter care may serve as an effective salvage treatment strategy.
Reference:Gong MY, Sun PP, Chen ZN, Li JA. Successful salvage of a PICC in catheter-related bloodstream infection caused by multidrug-resistant Ralstonia mannitolilytica using topical minocycline: a case report. BMC Infect Dis. 2026 Feb 16. doi: 10.1186/s12879-026-12900-y. Epub ahead of print. PMID: 41699501.