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Published on: February 23, 2014
Stenotrophomonas maltophilia: An Emerging Pathogen in Paediatric Population
Charu Nayyar1, Preeti Thakur1, Vibhor Tak2
1Senior Resident, Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya , Delhi, India .
Introduction:
Stenotrophomonas maltophilia (formerly Pseudomonas maltophilia/Xanthomonas maltophilia), a Gram- negative, non-fermenting bacillus, is being increasingly recognized as a threatening nosocomial pathogen, associated with significant mortality.
Aim:
To determine the prevalence of infection, antimicrobial susceptibility pattern and clinical outcome of S. maltophilia in a paediatric population.
Materials And Methods:
This was a retrospective study conducted over a period of eight months, i.e., October 2015 to May 2016. All clinical samples received in the microbiology laboratory during the study period were processed using standard microbiological procedures. S. maltophilia isolates were selected. Antibiotic susceptibility was performed for levofloxacin and trimethoprim-sulphamethoxazole by Vitek 2C system (Biomerieux, France). Average length of stay and mortality caused by S. maltophilia infection was compared with age and sex matched controls without S. maltophilia infection.
Results:
A total of 16,234 clinical specimens were received in the microbiology laboratory in the study period, with 2,734 pathogenic bacteria isolated. A total of 1,339 (1.7% of total isolates) Gram-negative bacteria were isolated, out of which 414 were non-fermenters. Among the non-fermenters, 23 (5.5%) were S. maltophilia. Out of the 23 isolates, 15 (65.2%) were isolated from blood, 4 (17.3%) were isolated from urine and tracheal aspirate each. A total of 91.3% of strains were susceptible and 8.6% were resistant to trimethoprim-sulphamethoxazole. Total 80% of strains were sensitive and 20% had intermediate susceptibility for levofloxacin. None of the strains were resistant to levofloxacin. Average length of stay of patients with S. maltophilia infection was found out to be 23.3 days as compared to 44.8 days in controls. The average mortality of patients with S. maltophilia infection was found to be same as that of controls (35.2%).
Conclusion:
S. maltophilia is becoming an important nosocomial pathogen and its isolation rate is reported to be increasing. Trimethoprim-sulphamethoxazole still remains the drug of choice but resistance has been reported for this drug as well. As its isolation is increasing, it is important to study the epidemiology, antimicrobial susceptibility profile and clinical outcomes of these isolates.
Insights
Stenotrophomonas maltophilia is an increasing nosocomial threat in children. Trimethoprim-sulphamethoxazole remains effective, though resistance is emerging, highlighting the need for ongoing surveillance of this pathogen.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Pediatrics
Background:
- Stenotrophomonas maltophilia (formerly Pseudomonas maltophilia) is an emerging Gram-negative nosocomial pathogen.
- This bacterium is associated with significant mortality rates in healthcare settings.
Purpose of the Study:
- To determine the prevalence of Stenotrophomonas maltophilia infections in a pediatric population.
- To analyze the antimicrobial susceptibility patterns of S. maltophilia isolates.
- To evaluate the clinical outcomes, including length of stay and mortality, associated with S. maltophilia infections.
Main Methods:
- Retrospective study over eight months (October 2015 - May 2016).
- Standard microbiological procedures for processing clinical samples.
- Antimicrobial susceptibility testing for levofloxacin and trimethoprim-sulphamethoxazole using Vitek 2C.
- Comparison of length of stay and mortality with age- and sex-matched controls.
Main Results:
- Stenotrophomonas maltophilia accounted for 5.5% of Gram-negative non-fermenter isolates.
- The majority of isolates were from blood (65.2%), urine, and tracheal aspirates (17.3% each).
- High susceptibility rates were observed for trimethoprim-sulphamethoxazole (91.3%) and levofloxacin (80% sensitive, 20% intermediate).
- Patients with S. maltophilia infection had a shorter average length of stay (23.3 days) compared to controls (44.8 days).
- Mortality rates were similar between infected patients and controls (35.2%).
Conclusions:
- Stenotrophomonas maltophilia is an increasingly significant nosocomial pathogen in pediatric populations.
- Trimethoprim-sulphamethoxazole remains a primary treatment option, but emerging resistance necessitates monitoring.
- Further epidemiological and clinical outcome studies are crucial due to rising isolation rates.
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