Treatment Outcomes of Stenotrophomonas maltophilia Bacteremia in Critically Ill Children: A Multicenter Experience

Itay Tokatly Latzer, Elhanan Nahum, Yuval Cavari, Isaac Lazar, Yossi Ben-Ari, Shalom Ben-Shimol, Gal Ben-Shalom, Yuval Geffen, Lior Goldberg, Marina Rubinstein, Nathan Keller, Itai M. Pessach, Gideon Paret

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objectives: Stenotrophomonas maltophilia is a gram-negative opportunistic bacterium that may cause a myriad of clinical diseases in immunocompromised individuals. We aimed to describe the clinical characteristics, risk factors, mortality, and treatment of S. maltophilia bacteremia in critically ill children, a topic on which data are sparse. Design: A multicenter observational retrospective study in which medical charts of critically ill children with S. maltophilia bacteremia were reviewed between 2012 and 2017. Setting: Data were collected from each of the four largest PICUs nationwide, allocated in tertiary medical centers to which children with complex conditions are referred regularly. Patients: A total of 68 suitable cases of S. maltophilia bacteremia were retrieved and reviewed. Measurements and Main Results: The total occurrence rate of S. maltophilia isolation had increased significantly during the study period (r = 0.65; p = 0.02). The crude mortality was 42%, and the attributed mortality was 18%. Significant risk factors for mortality were a longer length of hospital stay prior to infection (33 d in nonsurvivors vs 28 in survivors; p = 0.03), a nosocomial source of infection (p = 0.02), presentation with septic shock (p < 0.001), and treatment with chemotherapy (p = 0.007) or carbapenem antibiotics (p = 0.05) prior to culture retrieval. On multivariate analysis, septic shock (odds ratio, 14.6; 95% CI, 1.45-147.05; p = 0.023) and being treated with chemotherapy prior to infection (odds ratio, 5.2; 95% CI, 1.59-17.19; p = 0.006)] were associated with mortality. The combination of ciprofloxacin, trimethoprim-sulfamethoxazole, and minocycline resulted in the longest survival time (p < 0.01). Conclusions: The significant attributed mortality associated with S. maltophilia bacteremia in critically ill children calls for an aggressive therapeutic approach. The findings of this investigation favor a combination of trimethoprim-sulfamethoxazole, ciprofloxacin, and minocycline.

Original languageEnglish
Pages (from-to)e231-e239
JournalPediatric Critical Care Medicine
Volume20
Issue number5
DOIs
StatePublished - 1 May 2019
Externally publishedYes

Keywords

  • Stenotrophomonas Maltophilia
  • children
  • management
  • pediatric intensive care
  • pediatrics
  • treatment

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