Ralstonia pickettii: Two Cases of Bacteremia in a Moroccan Pediatric Intensive Care Unit.

Ralstonia pickettii is an emerging opportunistic pathogen in hospital settings, particularly affecting immunocompromised patients. Its ability to persist in aqueous solutions and colonize medical devices contributes to nosocomial outbreaks, complicating infection prevention and management strategies. We report two cases of R. pickettii bloodstream infections in the pediatric intensive care unit of a Moroccan university hospital. The first case involved an 11-month-old infant admitted with febrile respiratory distress. Despite initial treatment with imipenem and amikacin, R. pickettii bacteremia was diagnosed on day 30, requiring the addition of colistin and tigecycline. The clinical course was unfavorable, leading to death on day 40. The second case concerned a four-year-old child hospitalized for febrile status epilepticus. On day 10, a polymicrobial nosocomial infection involving Pseudomonas aeruginosa, Acinetobacter baumannii, and R. pickettii was identified, prompting treatment with colistin, tigecycline, and voriconazole. Despite therapeutic interventions, the patient succumbed to the infection on day 28. The emergence of R. pickettii as a nosocomial pathogen necessitates reinforced infection control measures, improved diagnostic capabilities, and the development of tailored therapeutic protocols. Strict adherence to aseptic procedures and continuous hospital surveillance are essential to prevent the spread of this opportunistic bacterium.