<i>Stenotrophomonas maltophilia</i> causing blood stream infection in neonates and infants: a cause for concern

Sah, Rinku; Siwakoti, Shraddha; Baral, Ratna; Rajbhandari, Rupa Singh

doi:10.1177/0049475517743360

Cited by 10 publications

(5 citation statements)

References 11 publications

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“…Finally, identification of the non-fermenters, P. aeruginosa, S. maltophilia, and A. baumannii will support the escalation of therapy, while broadening coverage to include the multi-drug resistance (MDR) of these bacteria (32)(33)(34)(35). The BCID-GN can provide information to hospital epidemiologists, infection preventionists, and bed management teams by providing faster Downloaded from https://journals.asm.org/journal/jcm on 13 July 2021 by 44.224.250.200. identification of MDR microbes, upon which to base isolation practices for microbes with the potential for healthcare-associated outbreaks (36)(37)(38).…”

Section: Discussionmentioning

confidence: 99%

A Multicenter Clinical Study To Demonstrate the Diagnostic Accuracy of the GenMark Dx ePlex Blood Culture Identification Gram-Negative Panel

Wolk

Young

Whitfield³

et al. 2021

J Clin Microbiol

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Bacteremia can progress to septic shock and death without appropriate medical intervention. Increasing evidence supports the role of molecular diagnostic panels in reducing the clinical impact of these infections through rapid identification of the infecting organism and associated antimicrobial resistance genes. We report the results of a multicenter clinical study assessing the performance of the GenMark Dx ePlex ® Investigational Use Only Blood Culture Identification Gram-Negative Panel (BCID-GN), a rapid diagnostic assay for detection of bloodstream pathogens in positive blood culture (PBC) bottles. Prospective, retrospective, and contrived samples were tested. Results from the BCID-GN were compared to standard of care bacterial identification methods. Antimicrobial resistance genes (ARGs) were identified using PCR and sequence analysis. The final BCID-GN analysis included 2,444 PBC samples, of which 926 were clinical samples with gram-negative Gram stain results. Of these, 109 samples had false negative and/or positive results, resulting in an overall sample accuracy of 88.2% (817/926). After discordant resolution, overall sample accuracy increased to 92.9% (860/926). Pre- and post-discordant resolution sample accuracy excludes 37 gram-negative organisms representing 20 uncommon genera, 10 gram-positive organisms, and 1 Candida sp. present in 5% of samples that are not targeted by the BCID-GN. The overall weighted PPA, which averages the individual PPAs from the 27 targets (gram-negative and ARG), was 94.9%. The limit of detection ranged from 10 4 to 10 7 CFU/mL, except for one strain of Fusobacterium necrophorum at 10 8 CFU/mL.

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Section: Discussionmentioning

confidence: 99%

A Multicenter Clinical Study To Demonstrate the Diagnostic Accuracy of the GenMark Dx ePlex Blood Culture Identification Gram-Negative Panel

Wolk

Young

Whitfield³

et al. 2021

J Clin Microbiol

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“…When examining outbreaks due to S. maltophilia reported in the literature, it was found that water and medical equipment were identified as possible sources in the foreground. However, outbreaks can be seen in different forms, such as in the contamination of dialysates used in dialysis centres or acute endophthalmitis outbreaks detected in eye centers where intravitreal injections are applied [13][14][15]. A study conducted in Mexico examined the blood and urine cultures of pediatric patients in the emergency room together with 21 S. maltophilia isolates taken from the taps of the same unit and found a total of 7 PFGE clones with 52% genetic variation [16].…”

Section: Discussionmentioning

confidence: 99%

An evaluation of a Stenotrophomonas maltophilia outbreak due to commercial arterial blood gas collection kit

Kazak,

Önal,

Tüzemen

et al. 2024

Antimicrob Resist Infect Control

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Background Stenotrophomonas maltophilia is a gram-negative bacterium that can cause hospital infections and outbreaks within hospitals. This study aimed to evaluate an outbreak of Stenotrophomonas maltophilia, caused by ready-to-use commercial syringes containing liquid lithium and heparin for arterial blood gas collection in a university hospital. Methods Upon detecting an increase in Stenotrophomonas maltophilia growth in blood cultures between 15.09.2021 and 19.11.2021, an outbreak analysis and a case-control study (52 patients for the case group, 56 patients for the control group) were performed considering risk factors for bacteremia. Samples from possible foci for bacteremia were also cultured. Growing bacteria were identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. The genetic linkage and clonal relationship isolates were investigated with pulsed-field gel electrophoresis (PFGE) in the reference laboratory. Results In the case-control study, the odds ratio for the central venous catheter [3.38 (95% confidence interval [CI]: 1.444, 8.705 ; p = 0.006)], for surgery [3.387 (95% confidence interval [CI]: 1.370, 8.373 ; p = 0.008)] and for arterial blood gas collection history [18.584 (95% confidence interval [CI]:4.086, 84.197; p < 0.001)] were identified as significant risk factors. Stenotrophomonas maltophilia growth was found in ready-to-use commercial syringes used for arterial blood gas collection. Molecular analysis showed that the growths in the samples taken from commercial syringes and the growths from blood cultures were the same. It was decided that the epidemic occurred because the method for sterilization of heparinized liquid preparations were not suitable. After discontinuing the use of the kits with this lot number, the outbreak was brought under control. Conclusions According to our results, disposable or sterile medical equipment should be included as a risk factor in outbreak analyses. The method by which injectors containing liquids, such as heparin, are sterilized should be reviewed. Our study also revealed the importance of the cooperation of the infection control team with the microbiology laboratory.

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“…It is a known cause of VAP and carries a high morbidity and mortality risk in neonates. 9,10 Treatment of infections caused by S. maltophilia may be a therapeutic challenge due to intrinsic resistance to multiple antibiotics, including carbapenems. Trimethoprim-sulfamethoxazole (TMP-SMX) is the mainstay of S. maltophilia treatment in adults, but can be challenging to administer in the neonate due to concerns of hyperbilirubinemia, bone marrow suppression and limited published data pertaining to appropriate dosing.…”

Section: Discussionmentioning

confidence: 99%

“…However, none of these antibiotics has been well studied in the preterm neonatal population for S. maltophilia infection. While there are no published CLSI susceptibility criteria for ciprofloxacin in treating S. maltophilia infections, it has been used successfully as monotherapy in a case of neonatal meningitis with bacteremia (20 mg/kg/d) 17 ; and in a cluster of 7 preterm neonates with bacteremia 9 ; as well as via topical nephrostomy tube instillation for a complicated S. maltophilia urinoma infection. 18 Amikacin and intravenous chloramphenicol (50 mg/kg/d) have been used in case studies for the treatment of S. maltophilia subdural empyema and intracranial abscess in a term neonate.…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Cefiderocol to Treat a Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Neonate

Koirala,

Krishnappa,

Banh

et al. 2023

Pediatric Infectious Disease Journal

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Background: Ventilator-associated pneumonia (VAP) caries a morbidity and mortality risk in the preterm neonate, particularly in the context of rising global antimicrobial resistance driving infections due to multidrug-resistant Gram-negative bacteria. Cefiderocol, a siderophilic cephalosporin, has broad Gram-negative antimicrobial activity and central nervous system penetration and is used for the treatment of hospital-acquired pneumonia or VAP in adults. Scarce data exists on its use in neonates. Case: A female neonate born at 26 + 6 weeks developed VAP at 21 days of life. She was commenced on corticosteroids, vancomycin and ceftazidime but continued to deteriorate. Sputum cultures yielded Stenotrophomonas maltophilia resistant to trimethoprim/sulfamethoxazole, ciprofloxacin and ceftazidime, with potential susceptibility to cefiderocol. Cerebrospinal fluid showed an elevated white cell count. In view of worsening respiratory and hemodynamic status, antibiotic treatment was changed to cefiderocol monotherapy at 30 mg/kg/dose every 8 hours. Within 72 hours of commencing cefiderocol, the neonate was successfully extubated to variable-flow continuous positive airway pressure and showed ongoing clinical improvement. Conclusions: Cefiderocol was integral for the care of our neonate without any immediate adverse safety consequences. We relied on dosing data from a conference abstract, due to the paucity of evidence on the use of novel antimicrobials. This lack of evidence is particularly concerning given preterm neonates are particularly vulnerable to infections with multidrug-resistant Gram-negative organisms due to their immature immune systems, prolonged hospital stay, repeated interventions and antimicrobial exposure.

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Stenotrophomonas maltophilia causing blood stream infection in neonates and infants: a cause for concern

Cited by 10 publications

References 11 publications

A Multicenter Clinical Study To Demonstrate the Diagnostic Accuracy of the GenMark Dx ePlex Blood Culture Identification Gram-Negative Panel

A Multicenter Clinical Study To Demonstrate the Diagnostic Accuracy of the GenMark Dx ePlex Blood Culture Identification Gram-Negative Panel

An evaluation of a Stenotrophomonas maltophilia outbreak due to commercial arterial blood gas collection kit

Successful Use of Cefiderocol to Treat a Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Neonate

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