REVIEW article
Front. Pediatr.
Sec. Pediatric Critical Care
Ralstonia pickettii as an Emerging Pediatric Pathogen: A Mini-Review of Current Evidence
Provisionally accepted
Christian Alberto Rodriguez-Saldaña1*
Mirtha Chiroque-Zavala1Milagros Quindes-Jaimes1Gianella María Muñoz-Vílchez1Karla Inés Alcántara-Sánchez1Adriana Montoya-Reátegui2Anabella Quiroga-Taboada3Luis Gabriel Farfán-Chávez4Daniel Reyes-Chávez4Juan José Flores-Rodriguez5- 1Department of Pediatrics, Peru–Korea Friendship Santa Rosa II-2 Hospital, Piura, Peru
- 2Department of Infectious Diseases, Peru–Korea Friendship Santa Rosa II-2 Hospital, Piura, Peru
- 3Department of Pediatrics, Hospital II Talara, Piura, Peru
- 4Department of Infectious Diseases, José Cayetano Heredia III-1 Hospital, EsSalud, Piura, Peru
- 5Department of Internal Medicine, José Cayetano Heredia III-1 Hospital, EsSalud, Piura, Peru
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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.
Keywords: Bacteremia, Bio-film, contaminated solutions, Healthcare-associated infection, neonatal intensive care, outbreak investigation, pediatric infections, Ralstonia pickettii
Received: 08 Dec 2025; Accepted: 19 Jan 2026.
Copyright: © 2026 Rodriguez-Saldaña, Chiroque-Zavala, Quindes-Jaimes, Muñoz-Vílchez, Alcántara-Sánchez, Montoya-Reátegui, Quiroga-Taboada, Farfán-Chávez, Reyes-Chávez and Flores-Rodriguez. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Christian Alberto Rodriguez-Saldaña
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.