Rapid containment of a hospital outbreak of Ralstonia mannitolilytica bloodstream infection linked to contaminated pre-filled 0.9% saline vials

Résumé fourni par la source

Abstract Background: Ralstonia species are environmental Gram-negative bacilli increasingly linked to healthcare-associated bloodstream infection (BSI) outbreaks from contaminated medical solutions. We describe an outbreak of Ralstonia mannitolilytica BSI in which the source was identified and withdrawn within 24 hours. Methods: Following an unusual cluster of R. mannitolilytica blood cultures on 29 September 2024 at a 700-bed tertiary-care hospital in Oman, we conducted a multidisciplinary investigation including chart review, hospitalwide surveillance, environmental and product sampling, antimicrobial susceptibility testing, and pulsed-field gel electrophoresis (PFGE) of clinical and product isolates. Results: Between 29 September and 8 October 2024, 21 patients met the case definition (median age 9 yr; 62% pediatric; 62% male; 95% immunocompromised; 86% with central venous access). Newly introduced pre-filled 10 mL 0.9% sodium chloride vials from a single manufacturer yielded R. mannitolilytica with concordant clinical and product antimicrobial susceptibility profiles. PFGE of 18 clinical isolates and one product isolate demonstrated 100% genetic relatedness, confirming a single-clone outbreak. The implicated product was withdrawn within 24 hours of cluster recognition. Thirteen of 21 patients had their central catheters removed; all received intravenous trimethoprim–sulfamethoxazole. Two patients experienced bacteremia recurrence after initial line retention; no outbreak-related deaths occurred. Conclusions: Prefilled saline vials can serve as the source of clonal R. mannitolilytica BSI outbreaks in immunocompromised patients. Laboratory-driven cluster detection, multidisciplinary coordination, and rapid product suspension enabled source identification within 24 hours and limited outbreak size and severity. Vigilance after introduction of new pharmaceutical products and prompt catheter removal in catheter-associated Ralstonia BSI are essential.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.