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Stenotrophomonas maltophilia bacteremia in pediatric patients-- a 10-year analysis
Ping-Sheng Wu1, Chun-Yi Lu, Luan-Yin Chang
1Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Background And Purpose:
Stenotrophomonas maltophilia bacteremia is an important cause of mortality among immunocompromised children. However, there has been little information concerning S. maltophilia bacteremia in the pediatric population.
Methods:
We reviewed the drug susceptibility of bloodstream isolates of S. maltophilia and medical charts of S. maltophilia bacteremia patients less than 18 years old at the Department of Pediatrics, National Taiwan University Hospital from January 1993 to June 2003. The risk factors associated with mortality of the patients with S. maltophilia bacteremia were analyzed.
Results:
In total, 32 episodes (31 patients) of S. maltophilia bacteremia were reviewed. The average rate of nosocomial bloodstream infection was 8.3 episodes per 100,000 patient-days, and an average of 6.4% of them were caused by S. maltophilia. Malignancy was the most common underlying disease (32%). Six episodes of S. maltophilia bacteremia had soft tissue involvement, and only 1 of them underwent surgical intervention and survived. These 32 isolates were most susceptible to trimethoprim-sulfamethoxazole (91%), and no obvious increase in multidrug resistance was noted in the previous 10 years. The crude mortality rate was 40.6%. Malignancy, failure to remove central venous catheter, and ineffective antibiotic treatment were significant risk factors for mortality.
Conclusions:
Early and effective antimicrobial therapy and removal of central venous catheter as soon as possible are vital for the successful management of S. maltophilia bacteremia.
Insights
Stenotrophomonas maltophilia bacteremia in children is serious, with a 40.6% mortality rate. Early, effective antibiotics and central venous catheter removal improve survival in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- Stenotrophomonas maltophilia bacteremia poses a significant mortality risk in immunocompromised children.
- Limited data exists on S. maltophilia bacteremia within the pediatric population.
Purpose of the Study:
- To investigate the characteristics and risk factors for mortality in pediatric S. maltophilia bacteremia.
- To analyze drug susceptibility patterns of S. maltophilia bloodstream isolates in children.
Main Methods:
- Retrospective review of medical charts and bloodstream isolates from pediatric patients (<18 years) with S. maltophilia bacteremia.
- Analysis of drug susceptibility and identification of mortality risk factors.
Main Results:
- 32 episodes of S. maltophilia bacteremia were identified; malignancy was the most common underlying condition (32%).
- The crude mortality rate was 40.6%. Significant risk factors for mortality included malignancy, central venous catheter presence, and ineffective antibiotic treatment.
- Trimethoprim-sulfamethoxazole showed high susceptibility (91%), with no significant increase in multidrug resistance over 10 years.
Conclusions:
- Effective antimicrobial therapy and prompt removal of central venous catheters are crucial for managing pediatric S. maltophilia bacteremia.
- Early intervention is vital for improving patient outcomes.