Bug in a Bottle – Report of an Outbreak Response in a Pediatric Oncology Unit

Abstract Healthcare-associated infection (HAI) outbreaks can result in significant morbidity and require prompt, coordinated responses to contain them. Immunocompromised children undergoing chemotherapy are particularly vulnerable to bloodstream infections (BSIs) caused by opportunistic pathogens. This report describes the investigation and management of an outbreak of BSI caused by an unusual organism, Ralstonia pickettii, in a Pediatric Oncology Department of a tertiary care hospital in India between May and June 2024. Nine children developed BSI at a median of 5 days following chemotherapy. A systematic epidemiological investigation, guided by national infection prevention and control guidelines, was undertaken, including root cause analysis and targeted environmental sampling. Six suspected medical products were cultured, of which sterile water for injection was identified as the source of contamination. Further testing of additional samples from the same batch confirmed contamination. Immediate withdrawal and recall of the implicated product effectively halted the outbreak. All affected patients responded to appropriate antibiotic therapy, although two experienced recurrent infections that required chemoport removal. No infection-related mortality was observed. This outbreak highlights the risk posed by contaminated liquid medical products in vulnerable populations. Vigilant surveillance, rapid identification of the source, and timely intervention are essential to control transmission and ensure patient safety.