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

Massimiliano Fabricci; Anaïs Trinca; Luca Talotti; Marina Busetti; Emmanouil Alexandros Fotakis; Christina Merakou; Raffaella Koncan; Annachiara Ghiotti; Camilla Negri; Vittorio Di Maso; Manuela Bosco; Alberto Antonelli; Marco Coppi; Gian Maria Rossolini; Claudia Giuliani; Enrico Scarpis; Barbara Gregoretti; Danilo Licastro; Roberto Luzzati; Venera Costantino; multidisciplinary working group; Multidisciplinary working group

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

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

Authors

Massimiliano Fabricci¹, Anaïs Trinca², Luca Talotti², Marina Busetti³, Emmanouil Alexandros Fotakis^{4

5}, Christina Merakou^{5

6}, Raffaella Koncan², Annachiara Ghiotti⁷, Camilla Negri⁸, Vittorio Di Maso⁹, Manuela Bosco¹⁰, Alberto Antonelli^{11

12}, Marco Coppi^{11

12}, Gian Maria Rossolini^{11

12}, Claudia Giuliani¹³, Enrico Scarpis¹³, Barbara Gregoretti¹, Danilo Licastro¹⁴, Roberto Luzzati^{15

2}, Venera Costantino³; multidisciplinary working group¹⁶; Multidisciplinary working group

Affiliations

¹ Medical Directorate, Trieste University Hospital (ASUGI), Trieste, Italy.
² Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
³ Microbiology Unit, Trieste University Hospital (ASUGI), Trieste, Italy.
⁴ ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
⁵ Italian National Institute of health (ISS), Rome, Italy.
⁶ ECDC fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
⁷ Department of Life Sciences, University of Trieste, Trieste, Italy.
⁸ Medical Directorate, Gorizia and Monfalcone Hospital (ASUGI), Gorizia and Monfalcone, Italy.
⁹ Nephrology and Dialysis Unit, Trieste University Hospital (ASUGI), Trieste, Italy.
¹⁰ Nephrology and Dialysis Unit, Gorizia and Monfalcone Hospital (ASUGI), Gorizia and Monfalcone, Italy.
¹¹ Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy.
¹² Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
¹³ Medical Directorate, Palmanova Hospital (ASUFC), Palmanova, Italy.
¹⁴ AREA Science Park, Trieste, Italy.
¹⁵ Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste, Italy.
¹⁶ The members of this group are listed under Collaborators.

PMID: 37440346
PMCID: PMC10347894
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
Ralstonia
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