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2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices.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.
Highlights
Solutions contaminated at the point of manufacture have been associated with outbreaks of BSIs or catheter-related infections.[4,5]
A case was defined using 2 criteria: (1) a positive R. pickettii culture using ≥1 samples of blood or fluid withdrawn via a catheter, and (2) injection-use 20-mL normal saline solution had been used to flush the patient’s catheter
All confirmed isolates were subjected to pulsed-field gel electrophoresis (PFGE)
Summary
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 departments, or hospital wards. All patients who were culture positive for R. pickettii from May 3 to June 11, 2015, were eligible for the study. Hospitalwide infection surveillance was conducted.[15] A case was defined using 2 criteria: (1) a positive R. pickettii culture using ≥1 samples of blood or fluid withdrawn via a catheter, and (2) injection-use 20-mL normal saline solution had been used to flush the patient’s catheter. This study and report were reviewed and approved, and an exemption was issued by our institutional review board
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