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Abstract

is a Gram-negative rod which may cause invasive infections when they contaminate liquid medical products. After was detected in blood cultures and a stem cell product from three patients in a tertiary care hospital in Germany, whole genome sequencing of these three isolates and two water isolates from the environment was performed. Core genome multilocus sequence typing analysis showed that the three patient isolates were closely related and there was a large distance to the environmental isolates. In a genomic comparison, the patients’ isolates were distantly related to an strain from a cluster in Australia suspected to be caused by contaminated saline produced in India, while all liquid medical products with a link to all patients were produced in Europe or the United States. Our data point towards an ongoing risk by an unknown common source that could be traced back to medical products contaminated with and potentially distributed worldwide. Investigating invasive infections, identifying and testing medical products administered to the patients and timely whole genome sequencing may help identify the exact source of this potentially global outbreak.

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/content/10.2807/1560-7917.ES.2024.29.3.2400010
2024-01-18
2024-11-24
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.3.2400010
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References

  1. Rajachandran K, Varghese GS, Kumar JV, Mathew KT. Outbreak of nosocomial infection from an unusual source. Indian J Crit Care Med. 2022;26(9):1042-4.  https://doi.org/10.5005/jp-journals-10071-24308  PMID: 36213706 
  2. Tejera D, Limongi G, Bertullo M, Cancela M. Ralstonia pickettii bacteremia in hemodialysis patients: a report of two cases. Rev Bras Ter Intensiva. 2016;28(2):195-8. PMID: 27410414 
  3. Ryan MP, Pembroke JT, Adley CC. Ralstonia pickettii: a persistent gram-negative nosocomial infectious organism. J Hosp Infect. 2006;62(3):278-84.  https://doi.org/10.1016/j.jhin.2005.08.015  PMID: 16337309 
  4. Baker MA, Rhee C, Tucker R, Vaidya V, Holtzman M, Seethala RR, et al. Ralstonia pickettii and Pseudomonas aeruginosa bloodstream infections associated with contaminated extracorporeal membrane oxygenation water heater devices. Clin Infect Dis. 2022;75(10):1838-40.  https://doi.org/10.1093/cid/ciac379  PMID: 35594555 
  5. Ryan MP, Adley CC. Ralstonia spp.: emerging global opportunistic pathogens. Eur J Clin Microbiol Infect Dis. 2014;33(3):291-304.  https://doi.org/10.1007/s10096-013-1975-9  PMID: 24057141 
  6. Ross B, Steinmann J, Buer J, Dusse F, Jakob H, Schneemann H, et al. [Outbreak with Ralstonia pickettii caused by contaminated magnesium vials]. Dtsch Med Wochenschr. 2014;139(7):323-6. German. PMID: 24496893 
  7. Moreira BM, Leobons MB, Pellegrino FL, Santos M, Teixeira LM, de Andrade Marques E, et al. Ralstonia pickettii and Burkholderia cepacia complex bloodstream infections related to infusion of contaminated water for injection. J Hosp Infect. 2005;60(1):51-5.  https://doi.org/10.1016/j.jhin.2004.09.036  PMID: 15823657 
  8. Sundaram S, Auriemma M, Howard G Jr, Brandwein H, Leo F. Application of membrane filtration for removal of diminutive bioburden organisms in pharmaceutical products and processes. PDA J Pharm Sci Technol. 1999;53(4):186-201. PMID: 10754712 
  9. Koch-Institut R. Häufung von Ralstonia pickettii. [Increased occurrence of Ralstonia pickettii]. Epid Bull. 2024;2:20. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/epid_bull_node.html
  10. Fabricci M, Trinca A, Talotti L, Busetti M, Fotakis EA, Merakou C, et al. A urokinase-associated outbreak of Ralstonia mannitolilytica bloodstream infections in haemodialysis patients in north-eastern Italy, January to April 2023. Euro Surveill. 2023;28(28):2300328.  https://doi.org/10.2807/1560-7917.ES.2023.28.28.2300328  PMID: 37440346 
  11. Mehra K, Khera D, Didel S, Tak V. Outbreak of Ralstonia pickettii blood stream infection in pediatric intensive care unit. Indian J Pediatr. 2023.  https://doi.org/10.1007/s12098-023-04973-3  PMID: 38095782 
  12. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 13.1. Växjö: EUCAST; 2023. Available from: ; http://www.eucast.org
  13. Department of Health and Aged Care. Recall: Logiwash and Legency Remedies sodium chloride 0.9% ampoules. Canberra: Australian Government; 2023. Available from: https://www.tga.gov.au/safety/product-recalls/recall-logiwash-and-legency-remedies-sodium-chloride-09-ampoules
  14. Department of Health and Aged Care. Safety alert: potential contamination of some saline products with Ralstonia pickettii. Canberra: Australian Government; 2023. Available from: https://www.tga.gov.au/news/safety-alerts/safety-alert-potential-contamination-some-saline-products-ralstonia-pickettii
  15. Chen YY, Huang WT, Chen CP, Sun SM, Kuo FM, Chan YJ, et al. An outbreak of Ralstonia pickettii bloodstream infection associated with an intrinsically contaminated normal saline solution. Infect Control Hosp Epidemiol. 2017;38(4):444-8.  https://doi.org/10.1017/ice.2016.327  PMID: 28115025 
  16. Lai HW, Shen YH, Chien LJ, Tseng SH, Mu JJ, Chan YJ, et al. Outbreak of Ralstonia pickettii bacteremia caused by contaminated saline solution in Taiwan. Am J Infect Control. 2016;44(10):1191-2.  https://doi.org/10.1016/j.ajic.2016.03.074  PMID: 27424301 
  17. Centers for Disease Control and Prevention (CDC). Nosocomial Ralstonia pickettii colonization associated with intrinsically contaminated saline solution--Los Angeles, California, 1998. MMWR Morb Mortal Wkly Rep. 1998;47(14):285-6. PMID: 9572669 
  18. Bedir Demirdag T, Ozkaya-Parlakay A, Bayrakdar F, Gulhan B, Kanik Yuksek S, Suzuk Yildiz S, et al. An outbreak of Ralstonia pickettii bloodstream infection among pediatric leukemia patients. J Microbiol Immunol Infect. 2022;55(1):80-5.  https://doi.org/10.1016/j.jmii.2020.12.004  PMID: 33461864 
  19. Lichtenegger S, Trinh TT, Assig K, Prior K, Harmsen D, Pesl J, et al. Development and validation of a Burkholderia pseudomallei core genome multilocus sequence typing scheme to facilitate molecular surveillance. J Clin Microbiol. 2021;59(8):e0009321.  https://doi.org/10.1128/JCM.00093-21  PMID: 33980649 
  20. Appelt S, Rohleder AM, Jacob D, von Buttlar H, Georgi E, Mueller K, et al. Genetic diversity and spatial distribution of Burkholderia mallei by core genome-based multilocus sequence typing analysis. PLoS One. 2022;17(7):e0270499.  https://doi.org/10.1371/journal.pone.0270499  PMID: 35793321 
Ralstonia pickettii bloodstream infections with potential genomic link to internationally distributed contaminated saline solution, Germany, October 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Manuel+Krone&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Krone Manuel</a>, <a href="/search?value1=Vera+Rauschenberger&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rauschenberger Vera</a>, <a href="/search?value1=Vera+Blaschke&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Blaschke Vera</a>, <a href="/search?value1=Heike+Claus&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Claus Heike</a>, <a href="/search?value1=Oliver+Kurzai&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kurzai Oliver</a>, <a href="/search?value1=Stefanie+Kampmeier&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kampmeier Stefanie</a></span>. Ralstonia pickettii bloodstream infections with potential genomic link to internationally distributed contaminated saline solution, Germany, October 2023. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(3):pii=2400010. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.3.2400010" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.3.2400010</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 03 Jan 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 12 Jan 2024 </span> </p>
/content/10.2807/1560-7917.ES.2024.29.3.2400010
/content/10.2807/1560-7917.ES.2024.29.3.2400010
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