Infections by Ralstonia Species in Clinical Settings

Ralstonia species are environmental, opportunistic Gram-negative bacilli increasingly recognised as agents of healthcare-associated infections. While historically considered of low virulence, these organisms can colonise water systems, medical fluids and invasive devices, leading to outbreaks in vulnerable patient groups such as neonates, oncology and haemodialysis patients. The principal human pathogens within the genus—Ralstonia pickettii, Ralstonia mannitolilytica and Ralstonia insidiosa—exhibit variable antimicrobial resistance, often driven by intrinsic β-lactamases and biofilm formation. Clinical manifestations range from bloodstream and catheter-related infections to pneumonia and surgical-site sepsis. Diagnostic challenges arise from phenotypic similarity to other non-fermenters and limitations of conventional identification systems. Advances in molecular methods, notably whole-genome sequencing and refined mass-spectrometry databases, have improved species delineation and enabled tracing of clonal outbreaks linked to contaminated saline, dialysis water and respiratory humidifiers. Heightened surveillance, stringent water-system maintenance, single-dose fluid protocols and antimicrobial stewardship remain central to prevention and control. The global scope of contamination events underscores the need for standardised contamination screening and rapid genomic epidemiology to avert widespread distribution of contaminated products.

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Infections by Ralstonia Species in Clinical Settings publication trend

The graph below shows the total number of articles in infections by ralstonia species in clinical settings across all publications each year (not limited to Nature Index journals).

Technical terms

Gram-negative bacillus: Rod-shaped bacterium with an outer membrane containing lipopolysaccharide, detectable by its resistance to decolourisation in Gram staining.

Nosocomial infection: Infection acquired in a hospital or other healthcare facility, often associated with medical devices or environmental reservoirs.

Biofilm: Structured community of microorganisms adherent to a surface and embedded in a self-produced extracellular matrix, contributing to persistence and antimicrobial tolerance.

Whole-genome sequencing: Comprehensive determination of the complete DNA sequence of an organism’s genome, enabling precise strain typing and resistance gene detection.

MALDI-TOF MS: Analytical technique that ionises microbial proteins to generate a mass spectrum fingerprint for rapid species-level identification.

References

1. Ralstonia pickettii bloodstream infections with potential genomic link to internationally distributed contaminated saline solution, Germany, October 2023. Eurosurveillance (2024).
2. Unveiling Ralstonia spp. in the Neonatal Intensive Care Unit: Clinical Impacts and Antibiotic Resistance. Antibiotics (2025).
3. Novel Ralstonia species from human infections: improved matrix-assisted laser desorption/ionization time-of-flight mass spectrometry-based identification and analysis of antimicrobial resistance patterns. Microbiology Spectrum (2024).