{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:27:54Z","timestamp":1790630874799,"version":"4.1.0"},"reference-count":20,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2017,1,24]],"date-time":"2017-01-24T00:00:00Z","timestamp":1485216000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec id=\"S0899823X16003275_abs1\" sec-type=\"general\"><jats:title>OBJECTIVE<\/jats:title><jats:p><jats:italic>Ralstonia pickettii<\/jats:italic> has caused contamination of pharmaceutical solutions in many countries, resulting in healthcare infections or outbreak events. We determined the source of the outbreak of <jats:italic>R. pickettii<\/jats:italic> bloodstream infection (BSI).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16003275_abs2\" sec-type=\"methods\"><jats:title>METHODS<\/jats:title><jats:p>This study was conducted in a 3,000-bed tertiary referral medical center in Taiwan with &gt;8,500 admissions during May 2015. Patients had been treated in the injection room or chemotherapy room at outpatient departments, emergency department, or hospital wards. All patients who were culture positive for <jats:italic>R. pickettii<\/jats:italic> from May 3 to June 11, 2015, were eligible for the study. The aim of the survey was to conduct clinical epidemiological and microbiological investigations to identify possible sources of infection.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16003275_abs3\" sec-type=\"results\"><jats:title>RESULTS<\/jats:title><jats:p>We collected 57 <jats:italic>R. pickettii<\/jats:italic>\u2013positive specimens from 30 case patients. We performed 24 blood cultures; 14 of these revealed &gt;2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices. All patients received an injection of 20 mL 0.9% normal saline via catheter flushing. In addition, 2 unopened ampules of normal saline solution (20 mL) were confirmed positive for <jats:italic>R. pickettii<\/jats:italic>. The Taiwan Centers for Disease Control and Prevention performed sampling and testing of the same manufactured batch and identified the same strain of <jats:italic>R. pickettii<\/jats:italic>. Pulsed-field gel electrophoresis tests revealed that all clinical isolates had similarity of &gt;90%, validating the outbreak of the same clone of <jats:italic>R. pickettii<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X16003275_abs4\" sec-type=\"conclusions\"><jats:title>CONCLUSIONS<\/jats:title><jats:p><jats:italic>R. pickettii<\/jats:italic> can grow in saline solutions and cause bloodstream infections. Hospital monitoring mechanisms are extremely important measures in identifying and ending such outbreaks.<\/jats:p><jats:p><jats:italic>Infect Control Hosp Epidemiol<\/jats:italic> 2017;38:444\u2013448<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2016.327","type":"journal-article","created":{"date-parts":[[2017,1,24]],"date-time":"2017-01-24T02:55:13Z","timestamp":1485226513000},"page":"444-448","source":"Crossref","is-referenced-by-count":44,"title":["An Outbreak of <i>Ralstonia pickettii<\/i> Bloodstream Infection Associated with an Intrinsically Contaminated Normal Saline Solution"],"prefix":"10.1017","volume":"38","author":[{"given":"Yin-Yin","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Tsuei","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Ping","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Mei","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu-Mei","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Jiun","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Chen","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu-Der","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2017,1,24]]},"reference":[{"key":"S0899823X16003275_ref14","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1177\/030089160308900528","article-title":"Outbreak of infusion-related septicemia by Ralstonia pickettii in the oncology department","volume":"89","author":"Marroni","year":"2003","journal-title":"Tumori"},{"key":"S0899823X16003275_ref13","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.054759-0"},{"key":"S0899823X16003275_ref16","doi-asserted-by":"publisher","DOI":"10.1086\/313458"},{"key":"S0899823X16003275_ref10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2180-11-194"},{"key":"S0899823X16003275_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2003.09.011"},{"key":"S0899823X16003275_ref3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1348-0421.1995.tb03275.x"},{"key":"S0899823X16003275_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2004.09.036"},{"key":"S0899823X16003275_ref6","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.40.7.2666-2667.2002"},{"key":"S0899823X16003275_ref18","doi-asserted-by":"publisher","DOI":"10.1099\/ijs.0.02555-0"},{"key":"S0899823X16003275_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2008.03.002"},{"key":"S0899823X16003275_ref2","first-page":"611","volume-title":"Bennett and Brachman\u2019s Hospital Infection","author":"Maki","year":"2007"},{"key":"S0899823X16003275_ref4","first-page":"285","article-title":"Nosocomial Ralstonia pickettii colonization associated with intrinsically contaminated saline solution\u2014Los Angeles, California, 1998","volume":"47","author":"Labarca","year":"1998","journal-title":"MMWR"},{"key":"S0899823X16003275_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2011.01.003"},{"key":"S0899823X16003275_ref7","doi-asserted-by":"publisher","DOI":"10.1097\/01.mph.0000149960.89192.b0"},{"key":"S0899823X16003275_ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s00248-012-0139-2"},{"key":"S0899823X16003275_ref11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1472-765X.2005.01737.x"},{"key":"S0899823X16003275_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2005.08.015"},{"key":"S0899823X16003275_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2014.08.041"},{"key":"S0899823X16003275_ref9","first-page":"323","article-title":"Outbreak with Ralstonia pickettii caused by contaminated magnesium vials","volume":"139","author":"Ross","year":"2014","journal-title":"Deut Med Wochenschr"},{"key":"S0899823X16003275_ref20","doi-asserted-by":"publisher","DOI":"10.2166\/wst.2013.332"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X16003275","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,4,17]],"date-time":"2019-04-17T21:55:31Z","timestamp":1555538131000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X16003275\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,24]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2017,4]]}},"alternative-id":["S0899823X16003275"],"URL":"https:\/\/doi.org\/10.1017\/ice.2016.327","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,24]]}}}