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Treatment Outcomes of Stenotrophomonas maltophilia Bacteremia in Critically Ill Children

A Multicenter Experience

Tokatly Latzer, Itay, MD1,2; Nahum, Elhanan, MD2,3; Cavari, Yuval, MD4; Lazar, Isaac, MD4; Ben-Ari, Yossi, MD5; Ben-Shimol, Shalom, MD6; Ben-Shalom, Gal, MD2,3; Geffen, Yuval, PhD7; Goldberg, Lior, MD1,2; Rubinstein, Marina, MD1,2; Keller, Nathan, MD8,9; Pessach, Itai M., MD, PhD1,2; Paret, Gideon, MD1,2

Pediatric Critical Care Medicine: May 2019 - Volume 20 - Issue 5 - p e231–e239
doi: 10.1097/PCC.0000000000001919
Online Clinical Investigations
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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.

1Pediatric Intensive Care Department, The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel.

2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

3Pediatric Intensive Care Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel.

4Pediatric Intensive Care Department, Soroka University Medical Center, affiliated to the Ben-Gurion Faculty of Medicine, Beer-Sheva, Israel.

5Pediatric Intensive Care Unit, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus affiliated to the Rappaport Faculty of Medicine, The Technion, Haifa, Israel.

6Pediatric Infectious Disease Unit, Soroka University Medical Center, affiliated to the Ben-Gurion Faculty of Medicine, Beer-Sheva, Israel.

7Clinical Microbiology Laboratory, Rambam Health Care Campus, affiliated to the Rappaport Faculty of Medicine, Technion, Haifa, Israel.

8Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children’s Hospital, Chaim Sheba Medical Center, Ramat-Gan, Israel.

9Department of Health Management, Ariel University, Ariel, Israel.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: itaylatzer@gmail.com

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies