Deep Incisional Surgical Site Infection Caused by Ralstonia pickettii

Ralstonia pickettii is an aerobic, nonfermentative gram-negative bacillus that can cause hospital-acquired infections by contaminated distilled water or chlorhexidine containing antiseptics. The two most common Ralstonia species in the clinical samples are R. pickettii and R. solanacearum. Infections caused by R. pickettii are very rare. These infections may appear as asymptomatic colonization or pseudo-bacteremia of respiratory system. The most common infections caused by R. pickettii are bacteremia and pneumonia. In the paper, a case of R. pickettii related deep incisional surgical site infectionis reported. A 63-year-old male patient with type-2 diabetes mellitus and coronary artery disease had coronary by-pass operation two-month ago. After the operation, patient had developed wound dehiscence and purulent discharge. Tissue biopsy culture performed in the setting revealed R. picketti. Patient was treated with 14 days of intravenous and 7 days of oral ciprofloxacin. His repeated cultures performed on the 14th day of ciprofloxacin did not yield any pathogen. To the knowledge, this is the first deep incisional surgical site infection caused by R. pickettii in the literature. The case is found to be of value because of emphasizing the importance of venture for diagnosis and rarity of R. pickettii in the etiology of soft tissue/surgical site infection.