Successful treatment of Stenotrophomonas maltophilia meningitis in a preterm baby boy: a case report

Abstract

IntroductionStenotrophomonas maltophilia is an important cause of hospital acquired infection particularly among severely debilitated and immunosuppressed patients.Case presentationWe report a case of S. maltophilia meningitis in a preterm baby boy after a neurosurgical procedure, successfully treated with trimethoprim-sulfamethoxazole and ciprofloxacin.ConclusionThis organism should be considered as a potential cause of meningitis and trimethoprim-sulfamethoxazole and ciprofloxacin are a combination that is successful and safe for treating preterm infants.

Stenotrophomonas maltophilia: an Emerging Global Opportunistic Pathogen

“…During 2004 to 2009, S. maltophilia clinical isolates recovered from the adult ICU of a tertiary care center in Saudi Arabia demonstrated major increases in resistance to gentamicin, while Ͼ90% of the isolates were susceptible to TMP-SMX (8). Recently, TMP-SMX was used in combination with ciprofloxacin to treat S. maltophilia meningitis in a preterm baby (284), but the emergence of resistance to TMP-SMX is forcing physicians to consider alternatives (7,245,328,333,357). Results from the SENTRY Antimicrobial Surveillance Program in 2004 showed a level of resistance to TMP-SMX of 3.8% for S. maltophilia (110), and results from the SENTRY Antimicrobial Surveillance Program in 1997 to 1999 showed a level of resistance of up to 10% across Europe (119).…”

“…The variety of infections associated with S. maltophilia is shown in Table 1. Infections associated with S. maltophilia include (most commonly) respiratory tract infections (pneumonia [115,310] and acute exacerbations of chronic obstructive pulmonary disease [COPD] [101,247]); bacteremia (182,187,236); biliary sepsis (261); infections of the bones and joints, urinary tract, and soft tissues (33,191,297,343); endophthalmitis (4); eye infections (keratitis, scleritis, and dacryocystitis [202,224,370]); endocarditis (19,135,171,237,326); and meningitis (243,284). S. maltophilia is a significant pathogen in cancer patients, particularly those with obstructive lung cancer.…”

Emerging Pathogens in Neonatal Bacterial Meningitis

“…So (Rojas et al, 2009) found S. maltophilia isolates were resistant to ampicillin, cefazolin and extended spectrum penicillins, but were susceptible to the aminoglycosides and trimethoprimsulfamethoxazole. It is resistant to a variety of antibiotics, for example aminoglycosides, ß-lactam agents and it is intrinsically resistant to carbapenems.…”

“…In our patients, the reported risk factors associated with emerging pathogens infection are prematurity, neurosurgical procedures (especially shunts and drainages), intracranial haemorrhages. Our current patients have been undergone several neurosurgical procedures and also, importantly, have been treated with a previous broad-spectrum antibiotic, which is also a suggested risk factor for infection with these emerging pathogens (Stenotrophomonas Maltophilia (Rojas et al, 2009), Kluyvera ascorbata (Rosso et al, 2007), Enterobacter sakazakii (Hunter et al, 2008) and Rhodococcus equi (Strunk et al, 2007). Although these pathogens are considered an infrequent cause of meningitis, it has become a focus of interest not only due to increasing recognition of its pathogenic potential but also because of its marked antibiotic resistance.…”

Early onset sepsis with pneumonia in a full term neonate due to Stenotrophomonas maltophilia

“…5 Two cases of late onset sepsis with meningitis were treated successfully with ciprofloxacin alone or in combination with cotrimoxazole. 6,7 Mother had no history of fever, UTI or prolonged rupture of membranes. Maternal swab, blood culture, and sampling of environmental sources were not done.…”