Risk Factors for Infection and Mortality Associated With Stenotrophomonas maltophilia Bloodstream Infections in Children; Comparison With Pseudomonas aeruginosa Bloodstream Infections

Bilen, Nimet Melis; Bal, Zümrüt Şahbudak; Özenen, Gizem Güner; Arslan, Sema; Özek, Gülcihan; Karadaş, Nihal; Yazici, Pınar; Çilli, Feriha; Kurugöl, Zafer

doi:10.1097/inf.0000000000003845

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…In our study, we checked our negative test for the FA-PP but did not detect S. maltophilia among these children. A possible issue arises from the absence of S. maltophilia in the FA-PP, as this bacterium is frequently seen among children in Türkiye and is known for its multidrug-resistant properties [21].…”

Section: Discussionmentioning

confidence: 99%

Supporting Clinical Decisions with Rapid Molecular Diagnostic Pneumonia Panel in Pediatric Intensive Care Unit: Single Center Experience in Turkiye

Bozan,

Kara,

Kiral

et al. 2023

Microorganisms

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Introduction: Lower respiratory tract infections are the leading cause of morbidity and mortality in children worldwide. It is crucial to promptly conduct diagnostic investigations in order to determine the microbiological cause of pneumonia, since this is necessary to ensure the appropriate delivery of antibiotic therapy to each individual patient. We evaluated the results of a rapid molecular diagnostic pneumonia panel in children with LRTI in a pediatric intensive care unit (PICU). Patients and Methods: Rapid molecular diagnostic pneumonia panel (BioFire®, FilmArray Pneumonia Panel plus; FA-PP) findings (71 results from 46 children) in a tertiary care PICU between 2019 and 2023 were retrospectively reviewed. Results: At least one bacterial pathogen was detected in 57 cases. A total of 77% of children had underlying conditions. A total of 70.4% of children needed invasive mechanical ventilation and 54.4% had ventilator-associated pneumonia. Pseudomonas aeruginosa (50.8%), Acinetobacter calcoaceticus baumannii complex (42%), and Klebsiella pneumoniae (38.6%) were the most common pathogens detected with the FA-PP. Of the 33 cases diagnosed with VAP, more than one pathogen was identified in 65.9% of cases, with the most commonly identified bacteria being K. pneumoniae (43.1%), P. aeruginosa (38.6%), and Acinetobacter calcoaceticus baumannii complex (31.8%). According to the FA-PP results, the same antibiotic therapy was continued in 39.4% of cases, escalated in 54.5%, and de-escalated in 6.1%. Conclusions: The utilization of the FA-PP has some beneficial effects, including more prompt delivery of findings compared to conventional approaches. Additionally, this approach enables the identification of resistance profiles in children diagnosed with pneumonia in the PICU. Consequently, these test results facilitate the organization of antibiotic treatment strategies, including escalation and de-escalation approaches. The detection of resistance patterns was exclusively determined via the implementation of molecular testing, prompting a reevaluation of the isolation technique in accordance with the obtained data.

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Section: Discussionmentioning

confidence: 99%

Supporting Clinical Decisions with Rapid Molecular Diagnostic Pneumonia Panel in Pediatric Intensive Care Unit: Single Center Experience in Turkiye

Bozan,

Kara,

Kiral

et al. 2023

Microorganisms

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“…The clinical epidemiology of the emerging NFGNB from recent studies is summarized in Table 1[45,46,61,70,72–97].…”

Section: Infections In Immunocompromised Hostmentioning

confidence: 99%

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Koulenti,

Vandana,

Rello

2023

Current Opinion in Infectious Diseases

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Purpose of review This article aims to review the epidemiology of nonfermenting Gram-negative bacilli (NFGNB) based on recent literature reports, particularly, of the less common, but with emerging clinical significance species. Recent findings The reported frequency of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa is increasing, with very significant variability, however, between different countries. Apart from the major NFGNB, that is, A. baumannii and P. aeruginosa, already recognized as of critical importance healthcare risks, several other NFGNB genera have been increasingly associated with diverse severe infections, such as Stenotrophomonas maltophilia, Burkholderia spp., Elizabethkingia spp., Chryseobacterium spp., Achromobacter spp., Alcaligenes spp., Sphingomonas spp., Shewanella spp. and Ralstonia spp., among others. Summary The exploration of the epidemiology, as well as the pathogenic potential of the of the less frequent, but emerging and increasingly reported NFGNB, is crucial, not only for immunocompromised patients, but also for critically ill patients without overt immunosuppression. As we are heading fast towards a postantibiotic era, such information would contribute to the optimal antimicrobial management, that is, providing prompt, appropriate antimicrobial coverage when needed and, at the same time, avoiding overuse and/or inappropriate use of antimicrobial therapy. Also, it would help to better understand their transmission dynamics and to develop effective prevention strategies.

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“…35,36,117,118 The most important risk factor for S. maltophilia infections in patients with hematologic malignancies is prior use of broad-spectrum therapies, particularly carbapenems. [119][120][121] Other risk factors in this population include acute leukemia, degree of neutropenia, mucositis, and presence of a central venous catheter. Risk scores based on some of these variables have been proposed to predict which patients may have S. maltophilia infections.…”

Section: S Maltophiliamentioning

confidence: 99%

“…S. maltophilia can account for 2%–7% of Gram‐negative BSIs in patients with hematologic malignancies 35,36,117,118 . The most important risk factor for S. maltophilia infections in patients with hematologic malignancies is prior use of broad‐spectrum therapies, particularly carbapenems 119–121 . Other risk factors in this population include acute leukemia, degree of neutropenia, mucositis, and presence of a central venous catheter.…”

Section: Resistant Bacteria That Cause Breakthrough Infections In Pat...mentioning

confidence: 99%

Global impact of antibacterial resistance in patients with hematologic malignancies and hematopoietic cell transplant recipients

Gottesdiener,

Satlin

2023

Transplant Infectious Dis

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Patients with hematologic malignancies and hematopoietic cell transplant (HCT) recipients are at high risk of developing bacterial infections. These patients may suffer severe consequences from these infections if they do not receive immediate effective therapies, and thus are uniquely threatened by antimicrobial‐resistant bacteria. Here, we outline how the emergence of specific resistant bacteria threatens the effectiveness of established approaches to prevent and treat infections in this population. The emergence of fluoroquinolone resistance among Enterobacterales and viridans group streptococci may decrease the effectiveness of fluoroquinolone prophylaxis during neutropenia. The emergence of Enterobacterales that produce extended‐spectrum β‐lactamases or carbapenemases and of increasingly resistant Pseudomonas aeruginosa may result in neutropenic patients experiencing delayed time to active antibacterial therapy, and consequently worse clinical outcomes. The ability to select targeted antibacterial therapies after the availability of susceptibility data may be limited in patients infected with metallo‐β‐lactamase‐producing Enterobacterales and difficult‐to‐treat P. aeruginosa. Vancomycin‐resistant enterococci and Stenotrophomonas maltophilia can cause breakthrough infections in patients already being treated with broad‐spectrum β‐lactam antibiotics. Resistance can also limit the ability to provide oral stepdown antibacterial therapy for patients who could otherwise be discharged from hospitalization. We also outline strategies that have the potential to mitigate the negative impact of antimicrobial resistance, including interventions based on active screening for colonization with resistant bacteria and the use of novel rapid diagnostic assays. Additional research is needed to better understand how these strategies can be leveraged to combat the emerging crisis of antimicrobial resistance in patients with hematologic malignancies and HCT recipients.

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Risk Factors for Infection and Mortality Associated With Stenotrophomonas maltophilia Bloodstream Infections in Children; Comparison With Pseudomonas aeruginosa Bloodstream Infections

Cited by 5 publications

References 21 publications

Supporting Clinical Decisions with Rapid Molecular Diagnostic Pneumonia Panel in Pediatric Intensive Care Unit: Single Center Experience in Turkiye

Supporting Clinical Decisions with Rapid Molecular Diagnostic Pneumonia Panel in Pediatric Intensive Care Unit: Single Center Experience in Turkiye

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Global impact of antibacterial resistance in patients with hematologic malignancies and hematopoietic cell transplant recipients

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