Ralstonia pickettii (RP), is a non-fermenting gram-negative bacillus. Infections due to RP are very rare in healthy individuals. However, RP hospital outbreaks have been reported and associated with extrinsic contamination of disinfectants... and other solutions used for patient care. To our knowledge this is the first case report of Ralstonia species causing infective endocarditis.

We report here a case of infective endocarditis due to RP in a 55-year old female patient, with a past medical history of gastritis treated by gastric pump inhibitor, presented after several days of worsening dyspnoea, low-grade fevers. Several weeks prior to presentation patient has had a colonos-copy. The evaluation in hospital, the patient was tachycardia with a pulse of 120 bpm, with a blood pressure of 106/54mmHg, and febrile to 39°C. ECG findings a atrial tachycardia (120 bpm), a transthoracic (TTE) and transesophageal echocardiogram (TEE confirmed presence of vegetation on the left coronary cusp and associated severe aortic regurgitation, with normal left ventricular systolic function. Blood cultures were obtained, and patient was initiated on empiric coverage for endocarditis. With installing maltolerance signs of tachycardia, patient was shocked by EEC. Repeat blood cultures on consecutive days were negatives (30 days). The patient was referred for emergent cardiothoracic surgery with replacement of the aortic valve. Surgical specimens from the aortic valve had heavy growth of RP. It was sensitive to ceftazidime, quinolones and imipenem. Her postoperative course was uneventful.

Patients with health care-associated infections or who have had recent hospitalization or medical intervention are a new risk group that requires careful diagnostic attention in the presence of fever to evaluate infective endocarditis. RP should be considered an important potential etiology of nosocomial infections.