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

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

Massimiliano Fabricci  1 , Anaïs Trinca  2 , Luca Talotti  2 , Marina Busetti  3 , Emmanouil Alexandros Fotakis  4   5 , Christina Merakou  5   6 , Raffaella Koncan  2 , Annachiara Ghiotti  7 , Camilla Negri  8 , Vittorio Di Maso  9 , Manuela Bosco  10 , Alberto Antonelli  11   12 , Marco Coppi  11   12 , Gian Maria Rossolini  11   12 , Claudia Giuliani  13 , Enrico Scarpis  13 , Barbara Gregoretti  1 , Danilo Licastro  14 , Roberto Luzzati  15   2 , Venera Costantino  3 ; multidisciplinary working group  16 ; Multidisciplinary working group
Collaborators, Affiliations

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

Massimiliano Fabricci et al. Euro Surveill. 2023 Jul.

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.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Ralstonia mannitolilytica bloodstream infections in haemodialysis patients in four hospitals, north-eastern Italy, January–April 2023 (n = 20)
Figure 2
Figure 2
Phylogenetic analysis of Ralstonia mannitolilytica clinical isolates (n = 19) and urokinase vials (batch no. NDY093B; n = 3), four hospitals in north-eastern Italy, January–April 2023
See this image and copyright information in PMC

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