Stenotrophomonas maltophilia bacteremia in children: risk factors and mortality rate

Mohammed Alsuhaibani,Sami Al-Hajjar,Abdulrahman Alsweed,Alanoud Aljarbou,Sahar Althawadi

doi:10.1186/s13756-021-00888-w

Abstract

PurposeStenotrophomonas maltophilia (S. maltophilia) is an opportunistic and nosocomial pathogen that can cause an invasive and fatal infection, particularly in hospitalized and immunocompromised patients. However, little is known about the impact of S. maltophilia bacteremia in pediatric patients. Therefore, we aimed to identify risk factors for mortality, antibiotics susceptibility to S. maltophilia, and mortality rates in pediatric patients with S. maltophilia bacteremia.MethodsWe conducted a retrospective cohort study by identifying all S. maltophilia positive blood cultures in the microbiology laboratory database between January 2007 and December 2018 from hospitalized pediatric patients (age 1–14 years). After identifying patients with S. maltophilia bacteremia, medical charts were reviewed for demographics, clinical data, and outcomes within seven days of bacteremia diagnosis. Risk factors associated with mortality in S. maltophilia bacteremia patients were determined using univariate and multivariate analyses.FindingsSixty-eight pediatric patients with S. maltophilia bacteremia were identified. All infections were nosocomial infections, and (88.2%) bacteremia cases were catheter-related bloodstream infections. On multivariate analysis, ICU admission prior to bacteremia episode and neutropenia were the major risk factors associated with mortality. S. maltophilia was the most susceptible to trimethoprim and sulfamethoxazole (TMP/SMX, 94.1%), followed by levofloxacin (85.7%). The overall mortality rate within seven days of S. maltophilia bacteremia diagnosis was 33.8%.ConclusionS. maltophilia bacteremia is a devastating emerging infection associated with high mortality among hospitalized children. Therefore, early diagnosis and prompt management based on local susceptibility data are crucial. Various risk factors, especially ICU admission prior to bacteremia episode and neutropenia, are associated with S. maltophilia bacteremia mortality.

Highlights

Stenotrophomonas maltophilia (S. maltophilia) is a non-fermenting, gram-negative bacillus that can cause opportunistic infections, especially in hospitalized and immunocompromised patients [1, 2] This organism could lead to invasive diseases, such as pulmonary, urinary, The intrinsic resistance of S. maltophilia to multiple antibiotics, including cephalosporins and meropenem, Alsuhaibani et al Antimicrob Resist Infect Control (2021) 10:19 which are commonly used for empiric therapy, makes it a therapeutic challenge
S. maltophilia bacteremia is a devastating emerging infection associated with high mortality among hospitalized children
This study aimed to identify the risk factors for mortality from S. maltophilia bacteremia, determine the antibiotic susceptibility profile of S. maltophilia, and determine the mortality rate in children with S. maltophilia bacteremia

Summary

Introduction

Stenotrophomonas maltophilia (S. maltophilia) is a non-fermenting, gram-negative bacillus that can cause opportunistic infections, especially in hospitalized and immunocompromised patients [1, 2] This organism could lead to invasive diseases, such as pulmonary, urinary, The intrinsic resistance of S. maltophilia to multiple antibiotics, including cephalosporins and meropenem, Alsuhaibani et al Antimicrob Resist Infect Control (2021) 10:19 which are commonly used for empiric therapy, makes it a therapeutic challenge. Trimethoprim/sulfamethoxazole (TMP/SMX) is the most effective antibiotic for S. maltophilia treatment, but resistance has been reported [9, 10]. S. maltophilia strains are resistant to several antibiotics, which make it a treatment challenge and life-threatening infection. Mortality can be as high as 69% but varies according to the associated risk factors [11, 12] in Saudi Arabia, Studies describing S. maltophilia bacteremia in children are limited [13, 14]. This study aimed to identify the risk factors for mortality from S. maltophilia bacteremia, determine the antibiotic susceptibility profile of S. maltophilia, and determine the mortality rate in children with S. maltophilia bacteremia

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