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Ralstonia pickettii outbreak in pediatric intensive care units, Peru-2025

Medalit Luna-Vilchez1,2, Mitsi Lorraine Santiago Abal3, Humania Aguirre Chávez3

  • 1Unidad de Atención Integral Especializada, https://ror.org/03yhwzd24Instituto Nacional de Salud del Niño San Borja, Lima, Perú.

Infection Control and Hospital Epidemiology
|May 28, 2026
PubMed
Abstract

Insights

A Ralstonia pickettii outbreak in a pediatric hospital was linked to contaminated dexmedetomidine. Genomic surveillance identified the source, leading to successful control by withdrawing the affected batch.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Public Health

Background:

  • Ralstonia spp. are opportunistic gram-negative bacilli found in aqueous environments.
  • Nosocomial outbreaks caused by Ralstonia spp. pose a significant threat in healthcare settings.
  • Dexmedetomidine is a commonly used sedative and analgesic in pediatric intensive care.

Purpose of the Study:

  • To describe an outbreak of Ralstonia pickettii bloodstream infections.
  • To identify the source and risk factors associated with the outbreak.
  • To evaluate the role of genomic surveillance in outbreak investigation.

Main Methods:

  • An outbreak investigation including a case-control study was conducted in a tertiary pediatric hospital.
  • Species identification was performed using MALDI-TOF MS.
  • Whole-genome sequencing and environmental sampling were utilized to identify the outbreak source and clonality.

Main Results:

  • Eleven Ralstonia pickettii bloodstream infections were identified, primarily in the Cardiovascular ICU.
  • Exposure to a contaminated dexmedetomidine batch was a significant risk factor (OR 18.75).
  • Genomic analysis confirmed clonal R. pickettii linked to contaminated dexmedetomidine, with identical bacteria isolated from the drug batch.

Conclusions:

  • This outbreak highlights the risk of intrinsically contaminated pharmaceuticals in global supply chains.
  • Manufacturing failures can lead to severe nosocomial infections.
  • Genomic surveillance is crucial for effective outbreak investigation and control.

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