Risk Factors of Stenotrophomonas maltophilia Blood Stream Infections: Comparison With Other Gram-Negative Blood Stream Infections in Children

Abstract

Background: Stenotrophomonas maltophilia, is a nonfermentative, aerobic, Gram-negative bacilli which is intrinsically resistance to several antibiotics. Treatment options for this bacteria are quite different from the other Gram-negative bacilli, which can represent a therapeutic challenge. To initiate appropriate empiric treatment and to reduce mortality, differentiation of S. maltophilia from other Gram-negative bacteria is critically important. The aim of this study is to distinguish the risk factors of S. maltophilia blood stream infections (BSI) from other Gram-negative BSI. Methods: This was a retrospective, case-control study. Patients with S. maltophilia BSI were selected as cases and patients with non-S. maltophilia Gram-negative BSI were selected as controls. Demographic and clinical characteristics of patients were recorded. Results: Forty-eight cases with S. maltophilia BSI and 144 controls were enrolled in the study. Risk factors for S. maltophilia BSI compared with the control group includes prior use of antibiotics, especially carbapenem, pediatric intensive care unit stay, mechanical ventilator use, indwelling catheters and duration of hospitalization. Conclusions: Breakthrough infection by S. maltophilia can occur in severely ill patients being treated with carbapenem. In the presence of risk factors, to reduce morbidity and mortality, S. maltophilia should be kept in mind when starting empiric treatment.

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

“…Several studies determined that previous use of antibiotics, particularly carbapenems, was associated with increased frequency and mortality of these infections. 4,6,11,19 Consistent with previous studies, we showed a higher previous carbapenem and glycopeptide use in deceased patients with S. maltophilia BSIs than in P. aeruginosa BSIs. Glycopeptide use was a risk factor for mortality in both groups, and carbapenem use was a risk factor for mortality in patients with S. maltophilia BSIs.…”

“…In our study, attributable mortality was 13.7%, which was less than in previous studies. 4,5,13 Our heterogeneous study group can explain this difference, which consisted of both critically ill and stable patients.…”

“…Urinary tract, gastrointestinal, skin, and soft tissue infections, bone and joint infections, meningitis, and endocarditis caused by S. maltophilia have also been reported. 1,4,5…”

“…Indwelling central venous catheters (CVC), previous use of broad-spectrum antibiotics, prolonged hospitalization, intensive care unit admission, malignancy, neutropenia, mechanical ventilation and malignancy have been described as possible risk factors for S. maltophilia BSIs. 1,4,5 S. maltophilia is intrinsically resistant to various antibiotics, including carbapenems which are commonly used to treat nosocomial infections. 1,6–8 Therefore, a delay in treatment can be life-threatening for the patients until culture results are available.…”

Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis

“…maltophilia and E. anophelis are not typical microbial populations found in the human body, but they have been detected in hospital settings, where they pose a risk as opportunistic pathogens for individuals with weakened immune systems. Host factors that increase the risk of S. maltophilia and E. anophelis infections include advanced age, neonate status, the presence of central venous catheters or indwelling devices, underlying malignancy, chronic respiratory disease, prior use of broad-spectrum antibiotics, long-term hospitalization or intensive care unit (ICU) stay, severe immunocompromise, particularly among recipients of haematopoietic stem cell transplantation, cytotoxic chemotherapy, radiotherapy, neutropenia therapy, immunosuppressive therapies, monoclonal antibodies, critical care in the ICU, and mechanical ventilation [28][29][30][31][32][33][34][35][36][37][38][39]. The presentation of S. maltophilia and E. anophelis infections depends on the infected site.…”