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Não fermentadores

Ralstonia pickettii

Thin Gram-negative bacilli

Identification & Growth

Identification

  • Oxidase-positive, slow-growing, small non-pigmented colonies
  • MALDI-TOF confirmation (older databases confuse it with Burkholderia)

Growth Conditions

  • Blood agar and MacConkey, 30–35 °C, 48–72 h

Clinical Significance

  • Pseudobacteremia and bacteremia from water, saline and contaminated solutions

Intrinsic Resistance

  • Intrinsic resistance to polymyxins and aminoglycosides

Bench Alerts

  • Several isolates in the same period point to contaminated supplies — activate infection control
  • No EUCAST/BrCAST disk breakpoints: report MIC using non-species-related (PK/PD) criteria

Clinical Notes

Clinical presentations

  • Causes bacteremia associated with contamination of intravenous solutions, distilled water, and sterile pharmaceutical products.
  • Associated with hospital outbreaks due to contaminated medical devices and disinfectants.
  • Rarely causes respiratory infections in patients with cystic fibrosis.

Specimens and collection

  • Serial blood cultures and culture of suspected solutions/products are essential in investigating supply-related contamination outbreaks.
  • Environmental samples of distilled water, saline solutions, and medical equipment should be collected during epidemiologic investigation.
  • Sputum or bronchoalveolar lavage is indicated in cystic fibrosis patients with respiratory symptoms.

Epidemiology and at-risk populations

  • Widely distributed in aquatic environments and capable of surviving and proliferating in distilled water and low-nutrient solutions.
  • Hospitalized patients with central venous catheters and use of contaminated intravenous solutions are the classic risk group.
  • Cystic fibrosis patients may present chronic airway colonization.

Resistance and therapeutic implications

  • Exhibits intrinsic resistance to several aminoglycosides and some beta-lactams, similar to other non-fermenting Gram-negative bacilli.
  • Trimethoprim-sulfamethoxazole and some carbapenems usually retain activity and are relevant therapeutic options.
  • Individualized susceptibility testing is essential due to the variable intrinsic resistance profile.

Bench and reporting notes

  • Non-fermenting, oxidase-positive Gram-negative bacillus that may be misidentified as Pseudomonas or Burkholderia by phenotypic testing.
  • MALDI-TOF or gene sequencing is recommended for definitive species identification.
  • Isolation in multiple patients with a common intravenous solution source should prompt immediate notification to infection control.

Sources

Educational decision-support content. It does not replace laboratory validation, current guidelines or review by the responsible professional.

FAQ: Frequently Asked Questions

How to identify Ralstonia pickettii in the lab?

Ralstonia pickettii is identified through oxidase-positive, slow-growing, small non-pigmented colonies, maldi-tof confirmation (older databases confuse it with burkholderia).

What are the intrinsic resistances of Ralstonia pickettii?

This organism is naturally resistant to intrinsic resistance to polymyxins and aminoglycosides. These drugs should not be reported as susceptible.

Where is Ralstonia pickettii commonly found?

It is typically associated with pseudobacteremia and bacteremia from water, saline and contaminated solutions.

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