An Analysis of the Etiology and Treatment of Ralstonia pickettii Bloodstream Infection in 2 Critically Ill Patients: A Case Report Highlighting an Emerging Pediatric Pathogen

<i>Ralstonia pickettii</i> are gram-negative bacilli primarily responsible for opportunistic nosocomial infections in immunocompromised patients. Outbreaks involving use of contaminated medical solutions as well as sporadic cases of meningitis, nosocomial pneumonia, infective endocarditis, and central line-associated bloodstream infection (CLABSI), have been reported in the past. Treatment is still not well-defined owing to its varied susceptibility to commonly used antibiotics, particularly carbapenems and aminoglycosides. The author reports 2 cases of CLABSI with <i>R. pickettii</i>, in pediatric patients from a tertiary care hospital in Karachi, Pakistan. First case was of a 12-day-old male with Atrial Septal Defect and Patent Ductus Arteriosus, who had a peripherally Inserted central catheter (PICC) placed to facilitate nutrition. Second case was of a 7-year-old male with known B-cell acute lymphoblastic leukemia (B-ALL), with PICC line in place for treatment. The antimicrobial susceptibility pattern of both isolates revealed resistance to aminoglycosides and meropenem, whereas trimethoprim-sulfamethoxazole was susceptible, paving the way for successful management in both cases and potentially serving as a valuable option against multidrug-resistant <i>R. pickettii</i> strains. To address these emerging pathogens, it is critical to implement a customized antibiotic policy and adhere to antimicrobial stewardship recommendations and infection control protocols.