Treatment Outcomes of Stenotrophomonas maltophilia Bacteremia in Critically Ill Children: A Multicenter Experience. Issue 5 (May 2019)

• Record Type: Journal Article
• Authors: Tokatly Latzer, Itay; Nahum, Elhanan; Cavari, Yuval; Lazar, Isaac; Ben-Ari, Yossi; Ben-Shimol, Shalom; Ben-Shalom, Gal; Geffen, Yuval; Goldberg, Lior; Rubinstein, Marina; Keller, Nathan; Pessach, Itai M.; Paret, Gideon
• Is Part Of: Pediatric critical care medicine. Volume 20:Issue 5(2019)
• Publication Date: 2019-05
• Subjects: children -- management -- pediatric intensive care -- pediatrics -- Stenotrophomonas Maltophilia -- treatment; Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000001919
• Languages: English
• ISSNs: 1529-7535

Abstract

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. Abstract : Supplemental Digital Content is available in the text.