Postoperative cerebrospinal fluid infection by Ralstonia mannitolilytica: Two case reports and a literature review

BACKGROUND: Ralstonia species are Gram-negative bacilli that are commonly found in moist environments, such as water and soil. They are opportunistic human pathogens, particularly found among immunocompromised patients, and are an infrequent cause of infection. The difficulty in correctly identifying and differentiating between Ralstonia species members using routine biochemical methods as well as their resistance to many classes of antibiotics poses a specific diagnostic and therapeutic challenge. CASE DESCRIPTION: We report two cases from our neurosurgical unit complicated by postoperative cerebrospinal fluid infection caused by Ralstonia Mannitolilytica that posed a therapeutic challenge. CONCLUSION: Our hypothesis is contaminated irrigation fluids might be a significant cause of post-operative meningitis and prolonged hospital stay.