Evaluation of Stenotrophomonas Maltophilia Bloodstream Infections in a Tertiary Pediatric Cardiovascular Surgery Intensive Care Unit in Turkey

Abstract

Background: Stenotrophomonas maltophilia poses a significant challenge as a drug-resistant opportunistic bacterium, particularly in ICU settings. However, its impact on pediatric ICU patients, especially those undergoing cardiovascular surgery, are scarce. Therefore, we aimed to analyze the factors behind S. maltophilia bloodstream infections (BSI) in our tertiary pediatric cardiovascular surgery ICU by evaluating the 2-year data. Methods: In this retrospective study, we analyzed data of 11 (mean age 20.3±17.6 months) and 18 cases (mean age 22.4±18.5 months) diagnosed with S. maltophilia BSI out of 635 and 685 children who underwent cardiovascular surgery from March 2021 to February 2022, and March 2022 to February 2023, respectively. Factors including age, gender, cardiac pathologies, surgical risk scores, duration of extracorporeal membrane oxygenation (ECMO) and mechanical ventilation, length of ICU stay, and use of broad-spectrum antibiotics were compared. Results: The incidence of S. maltophilia BSI increased by 50.5% in 2022-2023 compared to the previous year. While no significant differences were noted in age, gender, or surgical frequency, notable distinctions emerged in ECMO and mechanical ventilation durations, ICU length of stay, and broad-spectrum antibiotic usage (p values<0.05). Conclusion: Prolonged ECMO and mechanical ventilation, along with extended ICU stays and broad-spectrum antibiotic administration following highrisk cardiac surgeries, emerged as significant contributors to S. maltophilia BSI in our ICU. This underscores the necessity for a comprehensive approach encompassing infection control protocols, prudent antimicrobial utilization, and strategies to minimize invasive procedures. Such a multifaceted approach is paramount in mitigating the prevalence of S. maltophilia BSI, especially in high-risk ICU environments.