Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 26 , ISSUE 9 ( September, 2022 ) > List of Articles


Outbreak of Nosocomial Infection from an Unusual Source

Karthikkeyan Rajachandran, Giphy Susan Varghese, J Vinoth Kumar, Kukku Tresa Mathew

Keywords : Bacteremia, Fentanyl, Ralstonia pickettii

Citation Information : Rajachandran K, Varghese GS, Kumar JV, Mathew KT. Outbreak of Nosocomial Infection from an Unusual Source. Indian J Crit Care Med 2022; 26 (9):1042-1044.

DOI: 10.5005/jp-journals-10071-24308

License: CC BY-NC 4.0

Published Online: 31-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Hospital-acquired infections have been a wide-ranging concern in the medical field, as it increases mortality and incurs longer hospital stays and higher medical costs. Infection control practices and antimicrobial stewardship are thought to be emergent measures to curtail hospital-acquired infections, but adherence to such standard practices has been a concern globally, ultimately leading to poor clinical outcomes. Organisms isolated from rare sources have been reported to cause pathogenic infections in humans. Instances such as contamination of intravenous fluids and parenteral medications with gram-negative bacteria and fungus have been reported in the past. We present here, a rare outbreak of Ralstonia pickettii bacteremia from an unthought source among four critically ill patients. The epidemiological investigations confirmed the source of contagion to be fentanyl ampoules. The immediate action of disusing the batch of fentanyl ampoules was taken. Timely action and isolation precautions prevented a major outbreak within the intensive care unit (ICU).

PDF Share
  1. Zhang L, Morrison M, Rickard CM. Draft genome sequence of Ralstonia picketti AU12-08, isolated from an intravascular catheter in Australia. Genome Announc 2014;2(1):e00027-14. DOI: 10.1128/genomeA.00027-14.
  2. Tejera D, Limongi G, Bertullo M, Cancela M. Ralstonia picketti bacteremia in hemodialysis patients: A report of two cases. Rev Bras Ter Intensiva 2016;28(2):195–198. DOI: 10.5935/0103-507X.20160033.
  3. Ryan MP, Adley CC. Ralstonia spp: Emerging global opportunistic pathogens. Eur J Clin Microbiol Infect Dis 2014;33(3):291–304. DOI: 10.1007/s10096-013-1975-9.
  4. Chen YY, Huang WT, Chen CP, Sun SM, Kuo FM, Chan YJ, et al. An outbreak of Ralstonia pickettii bloodstream infection associated with an intrinsically contaminated normal saline solution. Infect Control Hosp Epidemiol 2017;38(4):444–448. DOI: 10.1017/ice.2016.327.
  5. Pellegrino FL, Schirmer M, Velasco E, de Faria LM, Santos KR, Moreira BM. Ralstonia pickettii bloodstream infections at a Brazilian cancer institution. Curr Microbiol 2008;56(3):219–223. DOI: 10.1007/s00284-007-9060-1.
  6. Zellweger C, Bodmer T, Tauber MG, Muhlemann K. Failure of ceftriaxone in an intravenous drug user with invasive infection due to Ralstonia pickettii. Infection 2004;32(4):246–248. DOI: 10.1007/s15010-004-3033-0.
  7. Ross B, Steinmann J, Buer J, Dusse F, Jakob H, Schneemann H, et al. Outbreak with Ralstonia pickettii caused by contaminated magnesium vials. Dtsch Med Wochenschr 2014;139(7):323–326. DOI: 10.1055/s-0033-1360059.
  8. Princess I, Vadala R. Clinical microbiology in the intensive care unit: Time for intensivists to rejuvenate this lost art. Indian J Crit Care Med 2021;25(5):566–574. DOI: 10.5005/jp-journals-10071- 23810.
  9. Khilnani GC, Zirpe K, Hadda V, Mehta Y, Madan K, Kulkarni A, et al. Guidelines for antibiotic prescription in intensive care unit. Indian J Crit Care Med 2019;23(Suppl. 1):S1–S63. DOI: 10.5005/jp-journals-10071-23101.
  10. Ryan MP, Adley CC. The antibiotic susceptibility of water-based bacteria Ralstonia pickettii and Ralstonia insidiosa. J Med Microbiol 2013;62(Pt 7):1025–1031. DOI: 10.1099/jmm.0.054759-0.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.