Persistent Bacteremia by Ralstonia mannitolilytica in a Patient Undergoing Haploidentical Stem Cell Transplant: An Odd Bug Out

Abstract In the current scenario, extensively drug-resistant (XDR) Enterobacterales , especially Klebsiella pneumoniae and Escherichia coli are the leading cause of bacteremia and sepsis. In neutropenic patients whose gut are colonized with XDR Enterobacterales , the primary suspect of persistent fever remains the colonized bug. We, hereby, discuss such a situation when a child who had undergone a haploidentical stem cell transplant continued to have fever despite multiple courses of antibiotics due to XDR bug infection and colonization. However, an odd bug, Ralstonia mannitolilytica became the real culprit in such a case of unexplained fever. The patient recovered fully only after the removal of the Hickman line.