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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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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| author | Dr Kelsi Marris Dr Ned Latham Dr Caitlin Swift Sandra Chaverot Dr Sally Ellis Narelle Dean Nerida Russell-Green Dr Benjamin Armstrong Vishal Ahuja Dr Kelly Tsang Dr Amanda Cuss Dr Kathy Dempsey Dr Kate Clezy Dr Therese Marfori Dr Gajan Perinpanayagam Dr Jordan Breed Frances Sheehan Dr Karina Kennedy Dr Jen Kok Dr Catherine Pitman Prof Vitali Sintchenko Dr Anthea Katelaris Dr Christine Selvey |
| author_facet | Dr Kelsi Marris Dr Ned Latham Dr Caitlin Swift Sandra Chaverot Dr Sally Ellis Narelle Dean Nerida Russell-Green Dr Benjamin Armstrong Vishal Ahuja Dr Kelly Tsang Dr Amanda Cuss Dr Kathy Dempsey Dr Kate Clezy Dr Therese Marfori Dr Gajan Perinpanayagam Dr Jordan Breed Frances Sheehan Dr Karina Kennedy Dr Jen Kok Dr Catherine Pitman Prof Vitali Sintchenko Dr Anthea Katelaris Dr Christine Selvey |
| author_sort | Dr Kelsi Marris |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-ecc86ff9b82642c796aad63b5d6d50d8 |
| institution | DOAJ |
| issn | 1201-9712 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | International Journal of Infectious Diseases |
| spelling | doaj-art-ecc86ff9b82642c796aad63b5d6d50d82025-08-20T02:55:13ZengElsevierInternational Journal of Infectious Diseases1201-97122025-03-0115210743110.1016/j.ijid.2024.107431A multijurisdictional healthcare-associated outbreak of Ralstonia pickettii from contaminated saline, Australia 2023Dr Kelsi Marris0Dr Ned Latham1Dr Caitlin Swift2Sandra Chaverot3Dr Sally Ellis4Narelle Dean5Nerida Russell-Green6Dr Benjamin Armstrong7Vishal Ahuja8Dr Kelly Tsang9Dr Amanda Cuss10Dr Kathy Dempsey11Dr Kate Clezy12Dr Therese Marfori13Dr Gajan Perinpanayagam14Dr Jordan Breed15Frances Sheehan16Dr Karina Kennedy17Dr Jen Kok18Dr Catherine Pitman19Prof Vitali Sintchenko20Dr Anthea Katelaris21Dr Christine Selvey22Public Health Unit, South Eastern Sydney Local Health District, Randwick, NSW, Australia; Public Health Officer Training Program, Centre for Epidemiology and Evidence, NSW Health, St Leonards, AustraliaCommunicable Disease Branch, Health Protection, NSW Health, St Leonards, Australia; Public Health Officer Training Program, Centre for Epidemiology and Evidence, NSW Health, St Leonards, AustraliaCommunicable Disease Branch, Health Protection, NSW Health, St Leonards, AustraliaPublic Health Unit, South Eastern Sydney Local Health District, Randwick, NSW, AustraliaCommunicable Disease Branch, Health Protection, NSW Health, St Leonards, AustraliaSt George Private Hospital, NSW, AustraliaSt George Private Hospital, NSW, AustraliaDouglass Hanly Moir Pathology, Macquarie Park, AustraliaNew South Wales Health Pathology - Public Health Pathology, NSW, AustraliaTherapeutic Goods Administration, Australian Department of Health and Aged Care, Canberra, AustraliaTherapeutic Goods Administration, Australian Department of Health and Aged Care, Canberra, AustraliaClinical Excellence Commission, Sydney, NSW, AustraliaClinical Excellence Commission, Sydney, NSW, AustraliaAustralian Capital Territory Health Directorate, ACT, AustraliaAustralian Capital Territory Health Directorate, ACT, AustraliaAustralian Capital Territory Health Directorate, ACT, AustraliaCanberra Hospital and Health Service, ACT, AustraliaCanberra Hospital and Health Service, ACT, AustraliaMicrobial Genomics Reference Laboratory, New South Wales Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead, AustraliaNew South Wales Health Pathology - Public Health Pathology, NSW, AustraliaMicrobial Genomics Reference Laboratory, New South Wales Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead, AustraliaPublic Health Unit, South Eastern Sydney Local Health District, Randwick, NSW, AustraliaCommunicable Disease Branch, Health Protection, NSW Health, St Leonards, AustraliaIntroduction: 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.http://www.sciencedirect.com/science/article/pii/S120197122400506X |
| spellingShingle | Dr Kelsi Marris Dr Ned Latham Dr Caitlin Swift Sandra Chaverot Dr Sally Ellis Narelle Dean Nerida Russell-Green Dr Benjamin Armstrong Vishal Ahuja Dr Kelly Tsang Dr Amanda Cuss Dr Kathy Dempsey Dr Kate Clezy Dr Therese Marfori Dr Gajan Perinpanayagam Dr Jordan Breed Frances Sheehan Dr Karina Kennedy Dr Jen Kok Dr Catherine Pitman Prof Vitali Sintchenko Dr Anthea Katelaris Dr Christine Selvey A multijurisdictional healthcare-associated outbreak of Ralstonia pickettii from contaminated saline, Australia 2023 International Journal of Infectious Diseases |
| title | A multijurisdictional healthcare-associated outbreak of Ralstonia pickettii from contaminated saline, Australia 2023 |
| title_full | A multijurisdictional healthcare-associated outbreak of Ralstonia pickettii from contaminated saline, Australia 2023 |
| title_fullStr | A multijurisdictional healthcare-associated outbreak of Ralstonia pickettii from contaminated saline, Australia 2023 |
| title_full_unstemmed | A multijurisdictional healthcare-associated outbreak of Ralstonia pickettii from contaminated saline, Australia 2023 |
| title_short | A multijurisdictional healthcare-associated outbreak of Ralstonia pickettii from contaminated saline, Australia 2023 |
| title_sort | multijurisdictional healthcare associated outbreak of ralstonia pickettii from contaminated saline australia 2023 |
| url | http://www.sciencedirect.com/science/article/pii/S120197122400506X |
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