Septic Shock After Kidney Transplant: A Rare Bloodstream Ralstonia mannitolilytica Infection

Xiangyong Tian,1,* Nan Jing,2,* Wenjing Duan,3 Xiaoqiang Wu,1 Chan Zhang,1 Shanmei Wang,2 Tianzhong Yan1 1Department of Urology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, People’s Republic of China; 2Department of Clinical Microbiology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, People’s Republic of China; 3Department of the Clinical Research Center, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Tianzhong Yan, Department of Urology, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, Henan Province, 450003, People’s Republic of China, Email ytz460@hotmail.com Wenjing Duan, Department of the Clinical Research Center, Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou, Henan Province, 450003, People’s Republic of China, Email duanwenjingzzu@zzu.edu.cnBackground: Ralstonia mannitolilytica, an emerging opportunistic pathogen, can infect immunocompromised patients but is a rare cause of severe sepsis and septic shock in kidney transplant recipients (KTRs).Case Presentation: We present a case of septic shock after renal transplant in a 41-year-old male, which was finally proven to be caused by Ralstonia mannitolilytica through blood cultures and mass spectrometric analysis following the negative result of metagenomic next-generation sequencing (mNGS). He was finally cured after the application of sensitive antibiotics (sulfamethoxazole-trimethoprim, amikacin and piperacillin-tazobactam) based on the drug sensitivity test results. The patient had a satisfactory recovery with no complications during a 6-month follow-up period.Conclusion: This study highlights that Ralstonia mannitolilytica is an easily overlooked cause of septic shock in KTRs requiring a detailed inquiry of medical history with inflammatory markers monitored closely. Traditional blood cultures still should be taken seriously. It also provides a cautionary tale that negative results of mNGS have to be interpreted with caution.Keywords: Ralstonia mannitolilytica, kidney transplant, sepsis, metagenomic next-generation sequencing, mNGS, blood cultures