A urokinase-associated outbreak of Ralstonia mannitolilytica bloodstream infections in haemodialysis patients in north-eastern Italy, January to April 2023

Euro Surveill. 2023 Jul;28(28):2300328. doi: 10.2807/1560-7917.ES.2023.28.28.2300328.

Abstract

An outbreak of Ralstonia mannitolilytica bloodstream infections occurred in four hospitals in north-eastern Italy, involving 20 haemodialysis patients with tunnelled central vascular catheter access. We identified as the outbreak source a batch of urokinase vials imported from India contaminated with R. mannitolilytica. Whole genome sequences of the clinical and urokinase strains were highly related, and only urokinase-treated patients were reported with R. mannitolilytica infections (attack rate = 34%; 95% confidence interval: 22.1-47.4). Discontinuation of the contaminated urokinase terminated the outbreak.

Keywords: Outbreak; Ralstonia; bacteraemia; catheter; dialysis; mannitolilytica; sepsis; urokinase.

MeSH terms

  • Disease Outbreaks
  • Gram-Negative Bacterial Infections* / diagnosis
  • Gram-Negative Bacterial Infections* / drug therapy
  • Gram-Negative Bacterial Infections* / epidemiology
  • Humans
  • Renal Dialysis / adverse effects
  • Sepsis* / epidemiology
  • Urokinase-Type Plasminogen Activator / genetics
  • Urokinase-Type Plasminogen Activator / therapeutic use

Substances

  • Urokinase-Type Plasminogen Activator

Supplementary concepts

  • Ralstonia mannitolilytica