{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:08:08Z","timestamp":1793502488265,"version":"4.5.0"},"reference-count":31,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Trop Doct"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Ralstonia<\/jats:italic>\n                      species are emerging nosocomial pathogens linked to significant clinical disease in high\u2013risk populations, particularly preterm neonates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To study the clinical and epidemiological characteristics including source identification of\n                      <jats:italic>Ralstonia<\/jats:italic>\n                      outbreak in NICU.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study was conducted in a tertiary care NICU in South India, identifying 14 cases of\n                      <jats:italic>Ralstonia<\/jats:italic>\n                      infection over two epochs: May to August 2021 and December 2022 to February 2023. We reviewed patient characteristics, clinical manifestations, antimicrobial profiles, and outcomes, alongside an epidemiological investigation for source identification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 14 cases, 13 were\n                      <jats:italic>R. mannitolilytica<\/jats:italic>\n                      and 1 was\n                      <jats:italic>R. pickettii<\/jats:italic>\n                      . No source was identified in the first epoch; however, contaminated sterile water ampoules used for IV preparations were implicated in the second. The mean gestation was 28 weeks (\u00b1 3), and the mean birth weight was 1192 g (\u00b1 539). Most neonates exhibited nonspecific symptoms. All isolates were sensitive to ciprofloxacin and trimethoprim\u2013sulfamethoxazole, with all cases recovering fully.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Teaching implications<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Ralstonia<\/jats:italic>\n                      species are capable of causing outbreaks and should prompt epidemiological surveillance for source identification. Clinical infection is usually mild with full recovery. Key interventions to prevent outbreaks include rigorous surveillance, infection control, and prompt antibiotic treatment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00494755251323683","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T02:36:21Z","timestamp":1741746981000},"page":"113-120","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Source identification and clinical outcomes of\n                    <i>Ralstonia<\/i>\n                    outbreaks in a neonatal intensive care unit: A case series from a tertiary care centre"],"prefix":"10.1177","volume":"55","author":[{"given":"Vineetha Prasad","family":"Nannapaneni","sequence":"first","affiliation":[{"name":"DM Postgraduate, Department of Neonatology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4021-4114","authenticated-orcid":false,"given":"Monisha","family":"Rameshbabu","sequence":"additional","affiliation":[{"name":"Assistant Professor, Department of Neonatology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subha","family":"Sundaramoorthy","sequence":"additional","affiliation":[{"name":"Consultant Microbiologist, Dr Rela Institute and Medical Centre, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7055-9131","authenticated-orcid":false,"given":"Giridhar","family":"Sethuraman","sequence":"additional","affiliation":[{"name":"Professor and HOD, Department of Neonatology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.2174\/1871526520666200330163504"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/00494755211036557"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1590\/0037-8682-0118-2018"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.inf.0000190059.54356.f3"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-016-2347-1"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.327"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1990.tb125422.x"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0195-6701(91)90076-K"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1348-0421.1995.tb03275.x"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1099\/00207713-23-1-15"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1099\/ijsem.0.005585"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1099\/ijsem.0.004332"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-013-1975-9"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1128\/aem.50.6.1343-1348.1985"},{"key":"e_1_3_2_16_2","first-page":"186","article-title":"Application of membrane filtration for removal of diminutive bioburden organisms in pharmaceutical products and processes","volume":"53","author":"Sundaram S","year":"1999","unstructured":"Sundaram S, Auriemma M, Howard Jr G, et al. Application of membrane filtration for removal of diminutive bioburden organisms in pharmaceutical products and processes. PDA J Pharm Sci Technol 1999; 53: 186\u2013201.","journal-title":"PDA J Pharm Sci Technol"},{"key":"e_1_3_2_17_2","first-page":"150","article-title":"Method for qualifying microbial removal performance of 0.1 micron rated filters. Part IV: retention of hydrogenophaga pseudoflava (ATCC 700892) and Ralstonia pickettii (ATCC 700591) by 0.2 and 0.22 micron rated filters","volume":"56","author":"Sundaram S","year":"2002","unstructured":"Sundaram S, Lewis M, Eisenhuth J, et al. Method for qualifying microbial removal performance of 0.1 micron rated filters. Part IV: retention of hydrogenophaga pseudoflava (ATCC 700892) and Ralstonia pickettii (ATCC 700591) by 0.2 and 0.22 micron rated filters. PDA J Pharm Sci Technol 2002; 56: 150\u2013171.","journal-title":"PDA J Pharm Sci Technol"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-3739"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1086\/313458"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2004.09.036"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1648243"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e31816454b7"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/0195-6701(90)90049-T"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.14776\/piv.2023.30.e4"},{"key":"e_1_3_2_25_2","article-title":"Clinical manifestation of Ralstonia mannitolilytica infection in pediatric patients and epidemiological investigation of outbreaks","volume":"38","author":"Kim G","year":"2023","unstructured":"Kim G, Yoo RN, So H, et al. Clinical manifestation of Ralstonia mannitolilytica infection in pediatric patients and epidemiological investigation of outbreaks. J Korean Med Sci 2023; 38: e252.","journal-title":"J Korean Med Sci"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1128\/genomeA.00405-15"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-017-0178-z"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.2807\/ese.18.18.20471-en"},{"key":"e_1_3_2_29_2","first-page":"257","article-title":"Case report: nosocomial Ralstonia pickettii infection in neonatal intensive care unit","volume":"38","author":"Adilo\u011flu AK","year":"2004","unstructured":"Adilo\u011flu AK, Ayata A, Sirin C, et al. Case report: nosocomial Ralstonia pickettii infection in neonatal intensive care unit. Mikrobiyol Bul 2004; 38: 257\u2013260.","journal-title":"Mikrobiyol Bul"},{"key":"e_1_3_2_30_2","first-page":"506","article-title":"Neonatal aspiration pneumonitis and endotracheal colonization with Burkholderia pickettii following home water birth","volume":"100","author":"Hagadorn JI","year":"1997","unstructured":"Hagadorn JI, Guthrie E, Atkins VA, et al. Neonatal aspiration pneumonitis and endotracheal colonization with Burkholderia pickettii following home water birth. Pediatrics 1997; 100: 506.","journal-title":"Pediatrics"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1202252"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1086\/519205"}],"container-title":["Tropical Doctor"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00494755251323683","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00494755251323683","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00494755251323683","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T13:36:58Z","timestamp":1777642618000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00494755251323683"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,11]]},"references-count":31,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1177\/00494755251323683"],"URL":"https:\/\/doi.org\/10.1177\/00494755251323683","relation":{},"ISSN":["0049-4755","1758-1133"],"issn-type":[{"value":"0049-4755","type":"print"},{"value":"1758-1133","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,11]]}}}