{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:29:15Z","timestamp":1762432155697,"version":"3.40.5"},"reference-count":58,"publisher":"Akademiai Kiado Zrt.","content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMicr"],"published-print":{"date-parts":[[2022,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n            <jats:p>\n               <jats:italic>Ralstonia pickettii<\/jats:italic> is an opportunistic bacterium found in the water environment with an increasing incidence as a nosocomial pathogen. The objectives of this study were to describe <jats:italic>R. pickettii<\/jats:italic> bacteremia in a cardiac surgery patient and to evaluate its ability to grow in a saline solution and to form biofilm. The patient in this study underwent mitral and aortic valve replacement surgery with two aortocoronary bypasses. She developed signs of respiratory and renal failure, therefore hemodialysis was started. After 25 days in an intensive care unit, the patient had recurrent episodes of fever with signs of bacteremia. <jats:italic>R. pickettii<\/jats:italic> was identified from blood cultures by MALDI-TOF MS. Antimicrobial susceptibility testing was performed using disc diffusion and broth microdilution methods in accordance with EUCAST methodology and results were interpreted following clinical breakpoints for <jats:italic>Pseudomonas<\/jats:italic> spp. The isolate was susceptible to all tested antimicrobial agents except aminoglycosides and colistin. Survival of <jats:italic>R. pickettii<\/jats:italic> was analyzed in saline solution with four different starting concentrations at 25 \u00b0C and 37 \u00b0C for six days. Biofilm capacity was tested using the microtiter plate method. <jats:italic>R. pickettii<\/jats:italic> showed substantial growth in saline solution, with starting concentration of 2\u2009CFU ml<jats:sup>\u22121<\/jats:sup> reaching 10<jats:sup>7<\/jats:sup>\u2009CFU ml<jats:sup>\u22121<\/jats:sup> after six days. There was no significant difference between growth at 25 \u00b0C and 37 \u00b0C. This indicates that storage of contaminated solutions at room temperature can enhance the count of <jats:italic>R. pickettii<\/jats:italic>. Our strain did not show the capacity to form biofilm. The patient responded well to adequate treatment with ceftazidime, and after 48 days in ICU she was discharged to convalesce.<\/jats:p>","DOI":"10.1556\/030.2022.01703","type":"journal-article","created":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T16:40:20Z","timestamp":1647535220000},"update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.1","source":"Crossref","is-referenced-by-count":3,"title":["Ralstonia pickettii bacteremia in a cardiac surgery patient in Belgrade, Serbia"],"prefix":"10.1556","author":[{"given":"Milos I.","family":"Jovicevic","sequence":"first","affiliation":[{"name":"University of Belgrade - Faculty of Medicine, Institute of Microbiology and Immunology, Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dragana R.","family":"Unic-Stojanovic","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute Dedinje, Belgrade, Serbia"},{"name":"University of Belgrade - Faculty of Medicine, Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Slobodanka V.","family":"Djukic","sequence":"additional","affiliation":[{"name":"University of Belgrade - Faculty of Medicine, Institute of Microbiology and Immunology, Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Snezana S.","family":"Brkic","sequence":"additional","affiliation":[{"name":"Institute for Laboratory Diagnostics \u201cKonzilijum\u201d, Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivana L.","family":"Djokovic","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute Dedinje, Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ljiljana D.","family":"Rankovic-Nicic","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute Dedinje, Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Slobodan Z.","family":"Tanaskovic","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute Dedinje, Belgrade, Serbia"},{"name":"University of Belgrade - Faculty of Medicine, Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1515-1824","authenticated-orcid":true,"given":"Ivana B.","family":"Cirkovic","sequence":"additional","affiliation":[{"name":"University of Belgrade - Faculty of Medicine, Institute of Microbiology and Immunology, Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"ref551","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jhin.2003.09.011","article-title":"Ralstonia pickettii outbreak associated with contaminated distilled water used for respiratory care in a paediatric intensive care unit","volume":"56","author":"Kendirli","year":"2004","journal-title":"J Hosp Infect"},{"key":"ref191","first-page":"150","article-title":"Method for qualifying microbial removal performance of 0.1 micron rated filters. 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Part IV: retention of hydrogenophaga pseudoflava (ATCC 700892) and Ralstonia pickettii (ATCC 700591) by 0.2 and 0.22 micron rated filters","volume":"56","author":"Sundaram","year":"2002","journal-title":"PDA J Pharm Sci Technol"},{"key":"ref531","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1099\/00207713-51-2-547","article-title":"Classification of Ralstonia pickettii biovar 3\/\u2018thomasii\u2019 strains (Pickett 1994) and of new isolates related to nosocomial recurrent meningitis as Ralstonia mannitolytica sp. nov","volume":"51","author":"De Baere","year":"2001","journal-title":"Int J Syst Evol Microbiol"},{"key":"ref501","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1128\/JCM.37.7.2158-2164.1999","article-title":"Identification of Burkholderia spp. in the clinical microbiology laboratory: comparison of conventional and molecular methods","volume":"37","author":"van Pelt","year":"1999","journal-title":"J Clin Microbiol"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s10096-013-1975-9","article-title":"Ralstonia spp.: emerging global opportunistic pathogens","volume":"33","author":"Ryan","year":"2014","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"ref91","first-page":"195","article-title":"Ralstonia pickettii bacteremia in hemodialysis patients: a report of two cases","volume":"28","author":"Tejera","year":"2016","journal-title":"Rev Bras Ter Intensiva"},{"key":"ref101","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1038\/sj.jim.7000273","article-title":"Survival and nutritional requirements of three bacteria isolated from ultrapure water","volume":"29","author":"McAlister","year":"2002","journal-title":"J Ind Microbiol Biotechnol"},{"key":"ref541","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1099\/jmm.0.054759-0","article-title":"The antibiotic susceptibility of water-based bacteria Ralstonia pickettii and Ralstonia insidiosa","volume":"62","author":"Ryan","year":"2013","journal-title":"J Med Microbiol"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1099\/00207713-23-1-15","article-title":"Pseudomonas pickettii, a new species of clinical origin related to Pseudomonas solanacearum","volume":"23","author":"Ralston","year":"1973","journal-title":"Int J Syst Bacteriol"},{"key":"ref141","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1128\/aem.50.6.1343-1348.1985","article-title":"Factors associated with Pseudomonas pickettii intrinsic contamination of commercial respiratory therapy solutions marketed as sterile","volume":"50","author":"Anderson","year":"1985","journal-title":"Appl Environ Microbiol"},{"key":"ref201","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1016\/S0015-0282(03)00254-1","article-title":"Seminal infection with Ralstonia picketti and cytolysosomal spermophagy in a previously fertile man","volume":"79","author":"Carrell","year":"2003","journal-title":"Fertil Steril"},{"key":"ref301","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.jhin.2005.08.015","article-title":"Ralstonia pickettii: a persistent gram-negative nosocomial infectious organism","volume":"62","author":"Ryan","year":"2006","journal-title":"J Hosp Infect"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.jhin.2005.08.015","article-title":"Ralstonia pickettii: a persistent gram-negative nosocomial infectious organism","volume":"62","author":"Ryan","year":"2006","journal-title":"J Hosp Infect"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1111\/j.1348-0421.1995.tb03275.x","article-title":"Transfer of two Burkholderia and an alcaligenes species to Ralstonia gen. nov.: Proposal of Ralstonia pickettii (Ralston, Palleroni and Doudoroff 1973) comb. nov., Ralstonia solanacearum (Smith 1896) comb. nov. and Ralstonia eutropha (Davis 1969) comb","volume":"39","author":"Yabuuchi","year":"1995","journal-title":"Nov Microbiol Immunol"},{"key":"ref171","article-title":"Ralstonia pickettii bacteremia: an emerging infection in a tertiary care hospital setting","volume":"11","author":"Nasir","year":"2019","journal-title":"Cureus"},{"key":"ref121","doi-asserted-by":"crossref","first-page":"E83","DOI":"10.1111\/hdi.12722","article-title":"Outbreak of nonfermentative Gram-negative bacteria (Ralstonia pickettii and Stenotrophomonas maltophilia) in a hemodialysis center","volume":"23","author":"Thet","year":"2019","journal-title":"Hemodialysis Int"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/1471-2180-11-194","article-title":"Genotypic and phenotypic diversity of Ralstonia pickettii and Ralstonia insidiosa isolates from clinical and environmental sources including High-purity Water. Diversity in Ralstonia pickettii","volume":"11","author":"Ryan","year":"2011","journal-title":"BMC Microbiol"},{"key":"ref361","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1097\/01.inf.0000190059.54356.f3","article-title":"Outbreak of Ralstonia pickettii bacteremia in a neonatal intensive care unit","volume":"24","author":"Kimura","year":"2005","journal-title":"Pediatr Infect Dis J"},{"key":"ref401","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1017\/ice.2016.327","article-title":"An outbreak of Ralstonia pickettii bloodstream infection associated with an intrinsically contaminated normal saline solution","volume":"38","author":"Chen","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"key":"ref161","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1055\/s-0029-1202252","article-title":"Ralstonia pickettii meningitis in a child with hydrocephalus","volume":"19","author":"Bonatti","year":"2009","journal-title":"Eur J Pediatr Surg"},{"key":"ref351","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s10096-013-1975-9","article-title":"Ralstonia spp.: emerging global opportunistic pathogens","volume":"33","author":"Ryan","year":"2014","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"ref521","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.2147\/IDR.S206492","article-title":"A case of persistent bacteraemia by Ralstonia mannitolilytica and Ralstonia pickettii in an intensive care unit","volume":"12","author":"Basso","year":"2019","journal-title":"Infect Drug Resist"},{"key":"ref371","article-title":"An outbreak of Ralstonia pickettii bloodstream infection among pediatric leukemia patients","volume":"6","author":"Bedir Demirdag","year":"2021","journal-title":"J Microbiol Immunol Infect"},{"key":"ref571","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2105\/AJPH.80.1.17","article-title":"Effect of disinfectants on pseudomonads colonized on the interior surface of PVC pipes","volume":"80","author":"Anderson","year":"1990","journal-title":"Am J Public Health"},{"key":"ref261","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jhin.2003.09.011","article-title":"Ralstonia pickettii outbreak associated with contaminated distilled water used for respiratory care in a paediatric intensive care unit","volume":"56","author":"Kendirli","year":"2004","journal-title":"J Hosp Infect"},{"key":"ref441","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1111\/j.1600-0463.2007.apm_630.x","article-title":"Quantification of biofilm in microtiter plates: overview of testing conditions and practical recommendations for assessment of biofilm production by staphylococci","volume":"115","author":"Stepanovi\u0107","year":"2007","journal-title":"APMIS"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1017\/ice.2016.327","article-title":"An outbreak of Ralstonia pickettii bloodstream infection associated with an intrinsically contaminated normal saline solution","volume":"38","author":"Chen","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"key":"ref181","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.main.2005.04.007","article-title":"Osteite du trap\u00e8ze a Ralstonia pickettii: a propos d'un cas et revue de la litt\u00e9rature [Ralstonia pickettii osteomyelitis of the trapezium]","volume":"24","author":"Degeorges","year":"2005","journal-title":"Chir Main"},{"key":"ref471","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.main.2005.04.007","article-title":"Osteite du trap\u00e8ze a Ralstonia pickettii: a propos d'un cas et revue de la litt\u00e9rature [Ralstonia pickettii osteomyelitis of the trapezium]","volume":"24","author":"Degeorges","year":"2005","journal-title":"Chir Main"},{"key":"ref341","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/1471-2180-11-194","article-title":"Genotypic and phenotypic diversity of Ralstonia pickettii and Ralstonia insidiosa isolates from clinical and environmental sources including High-purity Water. 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