title: An Outbreak of Ralstonia pickettii Bloodstream Infection Associated with an Intrinsically Contaminated Normal Saline Solution.
abstract: OBJECTIVE Ralstonia pickettii has caused contamination of pharmaceutical solutions in many countries, resulting in healthcare infections or outbreak events. We determined the source of the outbreak of R. pickettii bloodstream infection (BSI). METHODS This study was conducted in a 3,000-bed tertiary referral medical center in Taiwan with >8,500 admissions during May 2015. Patients had been treated in the injection room or chemotherapy room at outpatient departments, emergency department, or hospital wards. All patients who were culture positive for R. pickettii from May 3 to June 11, 2015, were eligible for the study. The aim of the survey was to conduct clinical epidemiological and microbiological investigations to identify possible sources of infection. RESULTS We collected 57 R. pickettii-positive specimens from 30 case patients. We performed 24 blood cultures; 14 of these revealed >2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices. All patients received an injection of 20 mL 0.9% normal saline via catheter flushing. In addition, 2 unopened ampules of normal saline solution (20 mL) were confirmed positive for R. pickettii. The Taiwan Centers for Disease Control and Prevention performed sampling and testing of the same manufactured batch and identified the same strain of R. pickettii. Pulsed-field gel electrophoresis tests revealed that all clinical isolates had similarity of >90%, validating the outbreak of the same clone of R. pickettii. CONCLUSIONS R. pickettii can grow in saline solutions and cause bloodstream infections. Hospital monitoring mechanisms are extremely important measures in identifying and ending such outbreaks. Infect Control Hosp Epidemiol 2017;38:444-448.
authors.affiliation: 1Department of Infection Control and Department of Nursing,Taipei Veterans General Hospital;National Yang-Ming University,Taipei,Taiwan.
authors.forename: Yin-Yin
authors.initials: YY
authors.lastname: Chen
authors.affiliation: 2Department of Infection Control and Department of Nursing,Taipei Veterans General Hospital,Taipei,Taiwan.
authors.forename: Wan-Tsuei
authors.initials: WT
authors.lastname: Huang
authors.affiliation: 2Department of Infection Control and Department of Nursing,Taipei Veterans General Hospital,Taipei,Taiwan.
authors.forename: Chia-Ping
authors.initials: CP
authors.lastname: Chen
authors.affiliation: 2Department of Infection Control and Department of Nursing,Taipei Veterans General Hospital,Taipei,Taiwan.
authors.forename: Shu-Mei
authors.initials: SM
authors.lastname: Sun
authors.affiliation: 3Department of Infection Control and Department of Pathology and Laboratory Medicine,Taipei Veterans General Hospital,Taipei,Taiwan.
authors.forename: Fu-Mei
authors.initials: FM
authors.lastname: Kuo
authors.affiliation: 4Department of Medicine,and Department of Pathology and Laboratory Medicine,Taipei Veterans General Hospital;National Yang-Ming University,Taipei,Taiwan.
authors.forename: Yu-Jiun
authors.initials: YJ
authors.lastname: Chan
authors.affiliation: 5National institute of Infectious Diseases and Vaccinology,National Health Research Institutes.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Kuo
authors.affiliation: 6Division of Infectious Diseases,Department of Infection Control,and Department of Medicine,Taipei Veterans General Hospital;National Yang-Ming University,Taipei,Taiwan.
authors.forename: Fu-Der
authors.initials: FD
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049920:Ralstonia pickettii; D012965:Sodium Chloride / Q000009:adverse effects*; D013624:Taiwan / Q000453:epidemiology; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D012965:Sodium Chloride