Ralstonia pickettii as an emerging pediatric pathogen: a mini-review of current evidence

Background: Ralstonia pickettii has gained relevance in pediatric healthcare due to its persistence in water systems, biofilm formation and contamination of medical solutions. This review summarizes current evidence on its epidemiology, environ-mental reservoirs, clinical features, diagnostic limitations and therapeutic considera-tions in children. Methods: A narrative search was conducted in PubMed, Scopus, Web of Science and Embase for studies published from January 1990 to 30 November 2025. Pediatric cases, outbreak reports, environmental studies with clinical relevance and microbiological reviews were included. Heterogeneity in design and reporting justified a narrative synthesis. Results: R. pickettii is the predominant Ralstonia species in pedi-atric infections and is closely linked to contaminated aqueous products and respiratory equipment. Neonates and immunocompromised children are most affected, with man-ifestations ranging from colonization to severe sepsis. Diagnostic systems frequently misidentify the organism, and molecular tools improve accuracy when combined with clinical assessment. Susceptibility patterns are variable and influenced by intrinsic re-sistance mechanisms and biofilm. Effective treatment often requires targeted therapy and device removal. Outbreak investigations consistently identify contaminated solu-tions and water systems as primary sources. Conclusions: R. pickettii is an emerging pathogen in pediatric care. Improving diagnostic accuracy, strengthening environ-mental control and ensuring safe handling of water-based solutions and medical devices are essential to reduce its clinical impact.