Ralstonia, a genus of gram-negative bacteria, was first described in 1995 as belonging to the family of Burkholderiaceae and class β-proteobacteria [[1], [2], [3]]. Ralstonia species are aerobic, non-fermentative, rod-shaped bacteria [4]. Currently, six species of the genus Ralstonia are known: Ralstonia insidiosa, Ralstonia mannitolilytica, Ralstonia pickettii, Ralstonia pseudosolanacearum, Ralstonia solanacearum, and Ralstonia syzygii [1,5]. Ralstonia species are ubiquitous, environmental bacteria and R. pseudosolanacearum, R. solanacearum, and R. syzygii are known as phytopathogens. R. insidiosa, R. mannitolilytica, and R. pickettii have occasionally been reported in patients under mechanical ventilation or suffering from cystic fibrosis [1,6]. These pathogens can be the causative agent of severe invasive infections including bacteremia (bloodstream infection, pneumonia, peritonitis, meningitis, endocarditis, spinal osteitis, osteomyelitis, septic arthritis, and prostatitis) [4]. Ralstonia pickettii and R. insidiosa are waterborne bacteria that can survive and grow in any kind of water source; they can cause nosocomial infections and are considered emerging pathogens of infectious diseases in hospital settings [4]. In particular, they can often lead to contamination of materials commonly used for inpatient care, such as intravenous drugs, blood culture bottles, distilled water, and solutions (saline and others) [7]. Furthermore, R. insidiosa has been shown to be a strong biofilm producer [6]. Solutions contaminated with Ralstonia species seem to be the most common cause of outbreaks in hospital settings [1].

The aseptic manufacturing process is essential to producing a sterile product and minimizing the contamination risk for patients. It involves multiple steps with sterile conditions for the handling of materials and medical equipment. The inappropriate preparation or microbial contamination of syringes during this process can lead to hospital-acquired blood infections associated with intravenous (i.v.) infusions [8]. Pharmaceutical solutions contaminated with the Ralstonia species and resulting in healthcare infections have been reported in several countries [9]. In this study, we describe nosocomial bloodstream infections caused by R. insidiosa and a monoclonal outbreak related to contaminated, commercial heparinized syringes.