{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T21:26:36Z","timestamp":1790630796461,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Hemodialysis International"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We report a case series of seven patients with nonfermentative Gram\u2010negative bacteria infections in a single dialysis center; four patients with <jats:italic>Ralstonia pickettii<\/jats:italic> and three patients with <jats:italic>Stenotrophomonas maltophilia<\/jats:italic>. Two of the seven patients were admitted to hospital for intravenous antibiotic treatment, while the rest were treated with oral antibiotics at home. Both the admitted patients had temporary vascular catheter infections from the aforementioned pathogens. We conclude that the outbreak is due to colonization of treated reverse osmosis water, presumably through contamination via polluted filters and compounded by the usage of reprocessed dialysers in the dialysis center. This is especially relevant because contaminated treated water is directly introduced into the blood compartment of the dialysers during reprocessing. In addition, there seems to be a propensity for both organisms to cause prolonged febrile reactions in patients with temporary vascular catheters, likely through the early development of biofilm. Intensification of general sterilization procedures, servicing and replacement of old decrepit components of the water treatment system and temporary cessation of dialyser reuse practice seem to have halted the outbreak. Due to the virulent nature and difficult resistant profile of nonfermentative Gram\u2010negative bacteria, we strongly recommend meticulous vigilance in the surveillance of culture isolates in routine microbiological specimens from dialysis centers, especially if there is a senescent water treatment system and a practice of reprocessing dialysers.<\/jats:p>","DOI":"10.1111\/hdi.12722","type":"journal-article","created":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T10:40:38Z","timestamp":1549968038000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Outbreak of nonfermentative Gram\u2010negative bacteria (<i>Ralstonia pickettii<\/i> and <i>Stenotrophomonas maltophilia<\/i>) in a hemodialysis center"],"prefix":"10.1111","volume":"23","author":[{"given":"May","family":"K. Thet","sequence":"first","affiliation":[{"name":"Department of Renal Medicine RIPAS Hospital  Bandar Seri Begawan Brunei Darussalam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma. Lourdes F.","family":"Pelobello","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine RIPAS Hospital  Bandar Seri Begawan Brunei Darussalam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine RIPAS Hospital  Bandar Seri Begawan Brunei Darussalam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed M.","family":"Alhaji","sequence":"additional","affiliation":[{"name":"PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam  Brunei Darussalam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vui Heng","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Medicine RIPAS Hospital  Bandar Seri Begawan Brunei Darussalam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Abdul Mabood","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine RIPAS Hospital  Bandar Seri Begawan Brunei Darussalam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terence","family":"Chinniah","sequence":"additional","affiliation":[{"name":"Department of Microbiology RIPAS Hospital  Bandar Seri Begawan Brunei Darussalam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackson","family":"Tan","sequence":"additional","affiliation":[{"name":"PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam  Brunei Darussalam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,2,12]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2014.08.041"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.4103\/0974-777X.121996"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.327"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2016.03.074"},{"key":"e_1_2_5_6_1","first-page":"416","article-title":"Are liquids an efficient vehicle of healthcare associated infections? 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