Ralstonia mannitolilytica infection in a tertiary care center: An outbreak report

This paper describes an outbreak of Ralstonia mannitolilytica infection declared at our facility between January-2021 and January-2022.

To identify the source of the outbreak, we applied widespread epidemiological investigations and infection control measures, including device isolation, environmental sampling, and pulsed-field gel electrophoresis typing.

Thirty-six cases of R mannitolilytica infection were identified, mostly adults (78%) and males (75%). Initially, neurological procedures were a common risk factor among cases, leading to sampling of related environmental settings. Cases with other medical procedures started to be reported. The pulsed-field gel electrophoresis results showed most R mannitolilytica isolates were indistinguishable, which expanded our investigation to all hospital areas. The outbreak source was traced to a specific lot of contaminated sodium chloride solution, which was recalled from all hospital units. The findings were reported to the Saudi Food and Drug Authority to communicate with the manufacturer and other health care organizations involved. No new cases of R mannitolilytica were identified thereafter.

It is essential to regularly monitor the compliance of manufacturers and suppliers with regulations related to the safety of solutions administered in medical practice. An extended incubation period might be considered to enhance the identification of R. mannitolilytica in future outbreaks.