Format

Send to

Choose Destination
Pediatr Crit Care Med. 2019 May;20(5):e231-e239. doi: 10.1097/PCC.0000000000001919.

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

Author information

1
Pediatric Intensive Care Department, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel.
2
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
3
Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
4
Pediatric Intensive Care Department, Soroka University Medical Center, affiliated to the Ben-Gurion Faculty of Medicine, Beer-Sheva, Israel.
5
Pediatric Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus affiliated to the Rappaport Faculty of Medicine, The Technion, Haifa, Israel.
6
Pediatric Infectious Disease Unit, Soroka University Medical Center, affiliated to the Ben-Gurion Faculty of Medicine, Beer-Sheva, Israel.
7
Clinical Microbiology Laboratory, Rambam Health Care Campus, affiliated to the Rappaport Faculty of Medicine, Technion, Haifa, Israel.
8
Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel.
9
Department of Health Management, Ariel University, Ariel, Israel.

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.

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center