Table 1 Synthetic overview of the outbreaks of bacterial and fungal contamination of infusates in healthcare facilities in low- and middle-income countries

Country income level

Low-income (LIC)

–

7

–

2

4

In total, reports originated from 17 countries, representing 2 LIC, 9 Lower-MIC and 6 Upper-MIC

Lower middle-income (lower-MIC)

2

12

2

6

25

Upper middle-income (upper-MIC)

9

5

1

8

21

Patients–wards–duration of outbreak

Median (range) duration: 8 weeks (1 day–156 weeks) (data: n = 43 articles)

Adults (A) and/or children (C) affected

1A/8C

6A/22C

1A/2C

8A/7C

16A/31C

Articles providing information about ward: n = 48

Articles providing information about duration: n = 45

Total number of patients affected: 1025

Total number of children affected: 761

Median (range) number of patients affected per outbreak: 12 [3] (3 - 185)

Median (range) case fatality ratio: 21.1% (0.0–87.5%) (data: n = 33 articles)

Neonatal Intensive care unit

6

16

1

5

19

Adult intensive care unit

–

2

–

3

7

Hematology/oncology

–

2

1

2

4

Other wards

3

10

2

9

23

Duration > 1 month

5

17

3

11

27

Duration > 3 months

3

13

2

7

16

Pathogens

Gram-negative bacteria (n = 59 isolates)

Enterobacterales (n = 29 isolates)

8

15

0

6

26

In 4 articles, more than 1 species was identified from the infusates [26, 35, 40, 66]

Where appropriate, the original (superseded) names of the bacteria are included in the comments to reflect taxonomic changes. They include:

Burkholderia cepacia—(Pseudomonas cepacia) [44]

Saprochaete capitata—(Blastoschizomyces capitatus) [42]

Pluralibacter gergoviae—(Enterobacter gergoviae) [54]

Elizabethkingia meningoseptica—(Chryseobacterium meningosepticum) [46]

Klebsiella aerogenes—(Enterobacter aerogenes) [61]

Rhizobium radiobacter—(Agrobacterium tumefaciens) [66]

Serratia sp.

2

3

–

2

7

Klebsiella sp.

1

9

–

3

10

Enterobacter sp.

2

1

–

1

4

Leclercia decarboxylata

1

–

–

–

1

Pantoea sp.

1

–

–

–

1

Phytobacter diazotrophicus

1

–

–

–

1

Pluralibacter gergoviae

–

1

–

–

1

Proteus mirabilis

–

1

–

–

1

NFGNB (n = 30 isolates)

2

11

5

11

25

Burkholderia cepacia complex

–

7

2

7

12

Ralstonia sp.

–

1

2

1

4

Acinetobacter baumannii

2

1

–

–

3

Achromobacter sp.

–

–

–

1

1

Elizabethkingia meningoseptica

–

1

–

–

1

Myroides odoratus

–

–

1

–

1

Pseudomonas sp.

–

1

–

1

2

Rhizobium radiobacter

–

–

–

1

1

Fungi (n = 3 isolates)

Candida albicans

1

–

–

–

1

Saprochaete capitata

–

1

–

–

1

Sarocladium kiliense

–

–

–

1

1

Gram-positive bacteria (n = 1 isolate)

Bacillus circulans

–

–

–

1

1

Contamination route

Intrinsic contamination

4

2

3

11

19

Articles providing information about intrinsic contamination: n = 19

Articles providing information or hypothesis about extrinsic contamination: n = 30

Extrinsic contamination

6

23

–

8

30

Used as mSDV

–

18

–

7

20

Used as admixture

–

6

–

–

5

Unsafe or deficient IPC practices

7

25

–

8

40