A multijurisdictional healthcare-associated outbreak of Ralstonia pickettii from contaminated saline, Australia 2023
Introduction: In September 2023, South Eastern Sydney Public Health Unit, in the state of New South Wales (NSW), Australia, was notified of five haematology/oncology inpatients with Ralstonia pickettii bloodstream infection from the same hospital ward. This organism is an uncommon cause of healthcar...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S120197122400506X |
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| Summary: | Introduction: In September 2023, South Eastern Sydney Public Health Unit, in the state of New South Wales (NSW), Australia, was notified of five haematology/oncology inpatients with Ralstonia pickettii bloodstream infection from the same hospital ward. This organism is an uncommon cause of healthcare-associated outbreaks, previously linked to contaminated healthcare fluids. Methods: A NSW outbreak management team was assembled, and later broadened to include other Australian states and territories. Laboratories, public health networks and clinicians were requested to notify R. pickettii detections to jurisdictional public health authorities. All available isolates were sequenced.Confirmed cases had laboratory evidence of R. pickettii, isolated since 1 August 2023, matching the outbreak strain on whole-genome sequencing (WGS). Probable cases had R. pickettii without WGS available.Case exposures were investigated through medical records, clinician interviews, and product procurement data. Microbiological testing of suspected products was conducted, and isolates were sequenced. The Therapeutic Goods Administration (TGA) investigated supply chains of suspected products. Results: 55 cases (41 confirmed, 14 probable) were identified across seven jurisdictions in Australia with samples collected between 1 August and 4 December 2023. R. pickettii was isolated from a variety of clinical sites including blood, urine and skin.After identification of a common product used in several cases, R. pickettii was cultured from a 30mL sodium chloride irrigation solution product. 46 (84%) of cases had definite or possible exposure to this product. All isolates (n=7) from this product were genomically indistinguishable to clinical isolates.From November, the TGA instituted consumer level recalls of the implicated product and three additional products manufactured at the same facility in India.The index case genome was shared using NCBI GenBank, and the outbreak findings and recall shared with the World Health Organization. Subsequent to the Australian outbreak investigation, batches of saline products made by the same manufacturer were recalled in the United Kingdom, after they were found to contain genomically-related Ralstonia pickettii. Discussion: WGS was vital in establishing links between patients in our outbreak with diverse epidemiology, and also internationally. Collaboration across jurisdictions and agencies facilitated source identification and product recall. Conclusion: This large multijurisdictional healthcare-associated outbreak was caused by intrinsic contamination of sterile saline. Ongoing review of manufacturing processes may identify a cause of the contamination. |
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| ISSN: | 1201-9712 |