Source identification and clinical outcomes of <i>Ralstonia</i> outbreaks in a neonatal intensive care unit: A case series from a tertiary care centre

Background<i>Ralstonia</i> species are emerging nosocomial pathogens linked to significant clinical disease in high-risk populations, particularly preterm neonates.ObjectiveTo study the clinical and epidemiological characteristics including source identification of <i>Ralstonia</i> outbreak in NICU.MethodsThis study was conducted in a tertiary care NICU in South India, identifying 14 cases of <i>Ralstonia</i> infection over two epochs: May to August 2021 and December 2022 to February 2023. We reviewed patient characteristics, clinical manifestations, antimicrobial profiles, and outcomes, alongside an epidemiological investigation for source identification.ResultsAmong the 14 cases, 13 were <i>R. mannitolilytica</i> and 1 was <i>R. pickettii</i>. No source was identified in the first epoch; however, contaminated sterile water ampoules used for IV preparations were implicated in the second. The mean gestation was 28 weeks (± 3), and the mean birth weight was 1192 g (± 539). Most neonates exhibited nonspecific symptoms. All isolates were sensitive to ciprofloxacin and trimethoprim-sulfamethoxazole, with all cases recovering fully.Teaching implications<i>Ralstonia</i> species are capable of causing outbreaks and should prompt epidemiological surveillance for source identification. Clinical infection is usually mild with full recovery. Key interventions to prevent outbreaks include rigorous surveillance, infection control, and prompt antibiotic treatment.