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treatment of ralstonia pickettii

Dear team,
Recently the germ Ralstonia pickettii was found in my sputum for the first time. It was resistant against all tested antibiotics. In between my sputum is tested in a more specialized lab but there is no result so far. These results shall help to organize the next infusions which are due in about 3 months.
My doctors at the cf-policlinic are not sure about the effect of this germ since there seems to be little experience. They asked me to do nothing at the moment since they hope the germ doesn’t change my situation for the worse.
I am very concerned and afraid to miss anything which might be useful or even essential to do shortly after this discovery. Somewhere on the internet I read that the fast discovery of Ralstonia pickettii allows a fast therapy with good results. But I have no idea what kind of therapy was meant.
Do you have any further experience?
Thank you very much.
Dear J.

Thank you for this question which I have asked one of our Consultant Phsycians to answer for you. Firstly it is important to identify this bacteria accurately. It can be mis-identified and I assume the more specialist lab will be carrying out genetic tests to make sure it is Ralstonia pickettii.

If it is, then deciding to treat can be difficult. It can chronically colonise the lungs in patients with CF and not cause an acute infection, therefore it would be reasonable just to monitor your health and await further information from the lab and your CF team. However if you are unwell with an infection and this is the only bacteria that can be identified then I suggest you speak to your team about more prompt treatment. Regarding antibiotics it is important to ask what antibiotics it has been tested against. Different labs may test a slightly different panel of antibiotics. The ralstonia group has been reported to be susceptible to co-trimoxazole and ciprofloxacin for example. But again it is important to identify the bacteria correctly and review the all the antibiotics tested against it. Sometimes in CF antibiotics that appear resistant in the lab may be beneficial clinically.

I hope this information is of help"

Damien Downey (Consultant Physician)
Judy Bradley
The answer is edited by: Prof Judy Bradley