An Australia‐wide epidemic ofPseudomonas pickettiibacteraemia due to contaminated “sterile” water for injection

Abstract

Nineteen cases of Pseudomonas pickettii bacteraemia and one case of Pseudomonas cepacia bacteraemia were identified in an Australia‐wide outbreak of nosocomial sepsis associated with contaminated water for injection. The contamination was limited to one batch of commercially produced water for injection. Four different organisms were identified (three biotypes of P. pickettii and one of P. cepacia). However, P. pickettii biotype 1 appeared to be relatively more virulent than the other biotypes as it was the only identified organism in blood cultures in nearly all cases of sepsis. The ampoules of “sterile” water were each contaminated with approximately 103organisms per millilitre. The lack of an Australian central reporting system for bacteraemia delayed the recognition of this outbreak.

Ralstonia pickettii: a persistent Gram-negative nosocomial infectious organism

“…28 These can be given intravenously, 8 given as a drip solution, 25 used to clean wounds, or used for endotracheal suctioning. 27 These have led to both bloodstream (bacteraemia) and respiratory infections.…”

“…2 The type species of the genus-R. pickettii (type strain, ATCC 27511 T )-was regarded originally as the only representative of clinical importance. [3][4][5][6][7][8][9][10][11] Recently, several novel Ralstonia spp. have been described that are of moderate clinical importance, including R. insidiosa 12 and R. mannitolytica.…”

Monoclonal outbreak of catheter-related bacteraemia by Ralstonia mannitolilytica on two haemato-oncology wards

“…9 Therefore, many of the cases of infection with R. pickettii were due to contaminated water or aqueous solutions given intravenously. 5,6,10,11 Interestingly, even ''sterile'' medical products like ranitidine 12 and saline solution 13,14 were reported to be contaminated with R. pickettii. Several infections of patients with permanent indwelling intravenous devices like central venous catheters or Port-A-Caths have been described.…”

Ralstonia pickettii and Burkholderia cepacia complex bloodstream infections related to infusion of contaminated water for injection

“…[2][3][4][5][6][7] In the present report, two outbreaks of R. pickettii and/or B. cepacia complex bloodstream infections (BSIs) are described: one at a small general hospital in 1995/1996 (Outbreak 1) and one at a neonatal intensive care unit (NICU) in 1998 (Outbreak 2) in Rio de Janeiro, Brazil. …”