Ralstonia pickettii can be isolated from water, soil and plants, and can also form part of the commensal flora of the oral cavity and the upper respiratory tract of healthy individuals. R. pickettii is an infrequent pathogen, but can cause infections, mainly of the respiratory tract, in immunocompromised and cystic fibrosis patients. It can be isolated from a variety of clinical specimens, including sputum, blood, wound infections, urine, ear and nose swabs, and cerebrospinal fluid. Resistance can occur to ciprofloxacin, trimethoprim–sulphamethoxazole, piperacillin–tazobactam, imipenem–cilastatin and ceftazidime. Early detection of R. pickettii allows prompt appropriate antimicrobial therapy with a favourable outcome, but removal of infected indwelling devices is mandatory.