Ralstonia mannitolilytica sepsis in neonatal intensive care unit – Be(a)ware of the multidrug resistant nosocomial bug

Ralstonia mannitolilytica, an emerging opportunistic pathogen is rarely isolated in neonatal units. We have elaborated our experience of managing its recent septic outbreak affecting four neonates in our intensive care unit over a span of five days. Three of the four had extremely low birth weight and had secondary clinical deterioration in the form of recurrent apnoea requiring intubation. All had thrombocytopenia. Their median age at clinical deterioration was 8 (4–12) days. The organism was multidrug resistant, but uniformly sensitive to flouroquinolones and co-trimoxazole, on which all recovered. Environmental samples were negative for the organism. There were no further positive cases. Early recognition and appropriate choice of drug will aid in fast recovery.