{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:28:13Z","timestamp":1790630893672,"version":"4.1.0"},"reference-count":18,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X26104486_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Ralstonia spp.<\/jats:italic>\n                      are opportunistic gram-negative bacilli that persist in aqueous environments and may cause nosocomial outbreaks. We describe an outbreak of bloodstream infections by\n                      <jats:italic>Ralstonia pickettii<\/jats:italic>\n                      associated with contaminated dexmedetomidine.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104486_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Outbreak investigation, including a case\u2013control study, was conducted in a tertiary pediatric hospital (July 19\u2013August 23, 2025), affecting the Cardiovascular, Pediatric, and Burn Intensive Care Units. Species identification was performed using MALDI-TOF MS. Whole-genome sequencing evaluated clonality and phylogenetic relationships with previously reported outbreaks. Environmental sampling and traceability of medical products identified the outbreak source.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104486_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Eleven\n                      <jats:italic>R. pickettii<\/jats:italic>\n                      bloodstream infections were identified, with 72.73% occurring in the Cardiovascular ICU. The median patient age was 6 months (IQR: 2 mo\u20137 yr), and fever was the predominant symptom (72.73%). The attack rate was 29.73%, and the case fatality rate was 27.27%. Significant risk factors included exposure to the implicated dexmedetomidine batch (OR 18.75, 95% CI 2.02\u2013173.00,\n                      <jats:italic>P<\/jats:italic>\n                      = .01) and higher dispensed quantity of dexmedetomidine (OR 1.33, 95% CI 1.07\u20131.67,\n                      <jats:italic>P<\/jats:italic>\n                      = .01). Genomic analysis confirmed clonal\n                      <jats:italic>R. pickettii<\/jats:italic>\n                      (rST-37,889) with close phylogenetic relatedness to outbreaks in Germany and Australia in 2023. All isolates harbored blaOXA-60, blaOXA-22, adeF, and vanH resistance genes. Identical\n                      <jats:italic>R. pickettii<\/jats:italic>\n                      was isolated from the implicated imported dexmedetomidine batch. The outbreak was controlled following withdrawal of the contaminated batch.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104486_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      This first reported outbreak of\n                      <jats:italic>R. pickettii<\/jats:italic>\n                      bloodstream infections linked to intrinsically contaminated dexmedetomidine highlights risks from manufacturing failures in global pharmaceutical supply chains and emphasizes the essential role of genomic surveillance in outbreak investigation.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2026.10448","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T07:14:32Z","timestamp":1779952472000},"page":"1-6","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["<i>Ralstonia pickettii<\/i>\n                    outbreak in pediatric intensive care units, Peru\u20142025"],"prefix":"10.1017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3351-7877","authenticated-orcid":false,"given":"Medalit","family":"Luna-Vilchez","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03yhwzd24","id-type":"ROR","asserted-by":"publisher"}],"name":"Instituto Nacional de Salud del Ni\u00f1o San Borja"},{"id":[{"id":"https:\/\/ror.org\/03deqdj72","id-type":"ROR","asserted-by":"publisher"}],"name":"Universidad de San Mart\u00edn de Porres"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsi Lorraine","family":"Santiago Abal","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Salud del Ni\u00f1o San Borja"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humania","family":"Aguirre Ch\u00e1vez","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Salud del Ni\u00f1o San Borja"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Cristel","family":"Marroqu\u00edn G\u00e1lvez","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Salud del Ni\u00f1o San Borja"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosario In\u00e9s","family":"Huasapoma Ortega","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Salud del Ni\u00f1o San Borja"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7836-3384","authenticated-orcid":false,"given":"Pool","family":"Flores Choque","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Salud del Ni\u00f1o San Borja"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0011-2665","authenticated-orcid":false,"given":"Jorge","family":"Osada","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Salud del Ni\u00f1o San Borja"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Flores-Le\u00f3n","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Salud"},{"name":"Universidad Privada San Juan Bautista"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1437-5607","authenticated-orcid":false,"given":"Ronnie G.","family":"Gavilan","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Salud"},{"name":"Universidad Privada San Juan Bautista"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7756-2097","authenticated-orcid":false,"given":"Lizbeth Vanessa","family":"Lozano Lozano","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Salud del Ni\u00f1o San Borja"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9193-820X","authenticated-orcid":false,"given":"Jorge Luis","family":"Salinas","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"S0899823X26104486_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2005.08.015"},{"key":"S0899823X26104486_ref16","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2024.29.27.2400384"},{"key":"S0899823X26104486_ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-023-04973-3"},{"key":"S0899823X26104486_ref12","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms10020292"},{"key":"S0899823X26104486_ref7","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-10071-24308"},{"key":"S0899823X26104486_ref9","unstructured":"9. 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Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}