Outbreak of Ralstonia pickettii associated with contamination of saline products distributed internationally, the United Kingdom, 2024

Author:

Saunders Mike12ORCID,Weaver Amy12ORCID,Stretch Rebecca2ORCID,Jeyaratnam D2ORCID,Mirfenderesky Mariyam2ORCID,Elliott David2ORCID,Patterson Charlotte2ORCID,Williams David2ORCID,Kenna Dervla TD2ORCID,Turton Jack2,Osman Karen L2ORCID,Turton Jane F2ORCID,Brown Colin S2,Elston JWT2ORCID

Affiliation:

1. These authors contributed equally to this work and share first authorship.

2. United Kingdom Health Security Agency (UKHSA), Colindale, United Kingdom

Abstract

We describe an outbreak of Ralstonia pickettii in the United Kingdom, with isolates genetically indistinguishable from a 2023 Australian outbreak linked to internationally distributed saline solutions. Confirmed cases (n = 3) had bacteraemia, clinically relevant infection, indwelling venous lines and frequent healthcare contact. Multi-stakeholder intervention was required including product recall and risk communications. We recommend a low threshold for investigating clusters of Ralstonia species and similar opportunistic pathogens, considering contaminated product sources. Effective mitigation requires multi-agency partnership and international collaboration.

Publisher

European Centre for Disease Control and Prevention (ECDC)

Reference13 articles.

1. Therapeutic Goods Administration (TGA). Recall: Logiwash and Legency Remedies Sodium Chloride 0.9% ampoules. Canberra: TGA; 18 Dec 2023. Available from: https://www.tga.gov.au/safety/product-recalls/recall-logiwash-and-legency-remedies-sodium-chloride-09-ampoules

2. Therapeutic Goods Administration (TGA). Recall: Interpharma Sodium Chloride 0.9% 30mL ampoules: Canberra: TGA; 1 Dec 2023. Available from: https://www.tga.gov.au/safety/product-recalls/recall-interpharma-sodium-chloride-09-30ml-ampoules

3. Ralstonia pickettii bloodstream infections with potential genomic link to internationally distributed contaminated saline solution, Germany, October 2023.;Krone;Euro Surveill,2024

4. New South Wales Health Pathology (NSW Health Pathology). Genome assembly ASM3380453v1. Newcastle: NSW Health Pathology; 2023. Available from: https://pathology.health.nsw.gov.au/services/genomics/

5. European Centre for Disease Prevention and Control (ECDC). Communicable disease threats report, 3-9 March 2024, week 10. Stockholm: ECDC

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