{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:28:37Z","timestamp":1791581317277,"version":"4.3.4"},"reference-count":43,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Federal Ministry of Health via the Robert Koch Institute, its National Reference\/Consiliary Laboratories Network","award":["09-47, FKZ 1369-359"],"award-info":[{"award-number":["09-47, FKZ 1369-359"]}]},{"name":"German Federal Ministry of Health via the Robert Koch Institute, its National Reference\/Consiliary Laboratories Network","award":["FKZ 1369-368"],"award-info":[{"award-number":["FKZ 1369-368"]}]},{"name":"German Federal Ministry of Health via the Robert Koch Institute, its National Reference\/Consiliary Laboratories Network","award":["IMS-RKI"],"award-info":[{"award-number":["IMS-RKI"]}]},{"name":"German Federal Ministry of Health via the Robert Koch Institute, its National Reference\/Consiliary Laboratories Network","award":["IMS-NRZ\/KL"],"award-info":[{"award-number":["IMS-NRZ\/KL"]}]},{"name":"National Consiliary Laboratory on Cystic Fibrosis Bacteriology","award":["09-47, FKZ 1369-359"],"award-info":[{"award-number":["09-47, FKZ 1369-359"]}]},{"name":"National Consiliary Laboratory on Cystic Fibrosis Bacteriology","award":["FKZ 1369-368"],"award-info":[{"award-number":["FKZ 1369-368"]}]},{"name":"National Consiliary Laboratory on Cystic Fibrosis Bacteriology","award":["IMS-RKI"],"award-info":[{"award-number":["IMS-RKI"]}]},{"name":"National Consiliary Laboratory on Cystic Fibrosis Bacteriology","award":["IMS-NRZ\/KL"],"award-info":[{"award-number":["IMS-NRZ\/KL"]}]},{"name":"Federal Ministry of Health on the basis of a decision by the German Bundestag","award":["09-47, FKZ 1369-359"],"award-info":[{"award-number":["09-47, FKZ 1369-359"]}]},{"name":"Federal Ministry of Health on the basis of a decision by the German Bundestag","award":["FKZ 1369-368"],"award-info":[{"award-number":["FKZ 1369-368"]}]},{"name":"Federal Ministry of Health on the basis of a decision by the German Bundestag","award":["IMS-RKI"],"award-info":[{"award-number":["IMS-RKI"]}]},{"name":"Federal Ministry of Health on the basis of a decision by the German Bundestag","award":["IMS-NRZ\/KL"],"award-info":[{"award-number":["IMS-NRZ\/KL"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>In December 2023, the World Health Organization reported an Australian nosocomial Ralstonia pickettii outbreak caused by contaminated saline solutions, causing bloodstream infections. The Antibiotic Resistance Surveillance, a Germany-wide laboratory network, has identified five R. pickettii-bacteraemia cases since August 2023 (0\u20131 annually 2019\u20132022), prompting an outbreak investigation to identify the source. We defined a case as a person with R. pickettii in any material (possible) or in blood culture (probable), confirmed if in the genetic outbreak cluster. We implemented nationwide R. pickettii surveillance, subjected isolates to core genome multilocus sequence typing, and compared cases by exposure, including medical products. From August 2023 to June 2024, we detected 25 cases. For eighteen cases, isolates were available, and sequences from six cases clustered within 6 allelic differences but showed &gt;43 allelic differences from Australian outbreak-associated sequences. These confirmed cases occurred in three hospitals across three federal states between October 2023 and March 2024, linked only by saline solution exposure. Four products and 11 lots matched across two of three hospitals. Retain sample testing remained negative. The R. pickettii outbreak in Germany was likely linked to saline solutions, although no product\/lot was confirmed. Tracing products\/lots was particularly challenging. Patient-level documentation of medical products\/lots and official mandates for the testing of retained samples could improve product traceback in future outbreaks.<\/jats:p>","DOI":"10.3390\/microorganisms13092102","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T12:15:17Z","timestamp":1757420117000},"page":"2102","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Nosocomial Outbreak of Ralstonia pickettii Infections Likely Linked to Saline Solutions in Germany from August 2023 to March 2024\u2014Challenges in Medical Product-Related Outbreaks"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7078-6537","authenticated-orcid":false,"given":"Mirco","family":"Sandfort","sequence":"first","affiliation":[{"name":"Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"von Laer","sequence":"additional","affiliation":[{"name":"Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5013-159X","authenticated-orcid":false,"given":"Stefanie","family":"Kampmeier","sequence":"additional","affiliation":[{"name":"Infection Control and Antimicrobial Stewardship Unit, University Hospital W\u00fcrzburg, 97080 W\u00fcrzburg, Germany"},{"name":"Institute for Hygiene and Microbiology, University of W\u00fcrzburg, 97070 W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inga","family":"Eichhorn","sequence":"additional","affiliation":[{"name":"Genome Competence Centre (MF 1), Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8164-7216","authenticated-orcid":false,"given":"Silver A.","family":"Wolf","sequence":"additional","affiliation":[{"name":"Genome Competence Centre (MF 1), Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9150-0876","authenticated-orcid":false,"given":"Maximilian","family":"Driller","sequence":"additional","affiliation":[{"name":"Genome Competence Centre (MF 1), Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9922-7154","authenticated-orcid":false,"given":"Vladimir","family":"Baji\u0107","sequence":"additional","affiliation":[{"name":"Genome Competence Centre (MF 1), Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4964-4468","authenticated-orcid":false,"given":"Somayyeh","family":"Sedaghatjoo","sequence":"additional","affiliation":[{"name":"Genome Competence Centre (MF 1), Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Genome Competence Centre (MF 1), Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Engelhart","sequence":"additional","affiliation":[{"name":"Institute for Hygiene and Public Health, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0156-9595","authenticated-orcid":false,"given":"Nico T.","family":"Mutters","sequence":"additional","affiliation":[{"name":"Institute for Hygiene and Public Health, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther P.","family":"C\u00f3nsul-Tejero","sequence":"additional","affiliation":[{"name":"Federal Institute for Drugs and Medical Devices (BfArM), 53175 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Z\u00fcndorf","sequence":"additional","affiliation":[{"name":"Federal Institute for Drugs and Medical Devices (BfArM), 53175 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Eckmanns","sequence":"additional","affiliation":[{"name":"Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hogardt","sequence":"additional","affiliation":[{"name":"German National Consiliary Laboratory on Cystic Fibrosis Bacteriology, 60596 Frankfurt am Main, Germany"},{"name":"Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University, 60596 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8242-711X","authenticated-orcid":false,"given":"Sebastian","family":"Haller","sequence":"additional","affiliation":[{"name":"Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ryan, M.P., Pembroke, J.T., and Adley, C.C. 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