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Stenotrophomonas maltophilia in Hemodialysis: An Opportunistic Pathogen or a Malevolent Foe
Tamilarasan V1, Jagan V1, Leela Kv1
1Microbiology, SRM Medical College Hospital and Research Centre, Chennai, IND.
Abstract:
Catheter-related bloodstream infections (CRBSIs) add to the morbidity and mortality of hemodialysis patients. Stenotrophomonas maltophilia is an extremely resistant, gram-negative, non-lactose-fermenting nosocomial bacterium that contributes significantly to mortality and morbidity. This bacterium is predominantly associated with community-acquired pneumonia, bacteremia, eye afflictions, biliary sepsis, urinary tract infection, skin and soft tissue infection, and very rarely chronic enteritis with colonic ulcers. Here, we present two cases that presented indolently and exhibit strikingly contrasting behaviors. The first case was a patient with primary hyperoxaluria on maintenance hemodialysis, who presented with CRBSI due to S. maltophilia, which responded appropriately to catheter removal and levofloxacin. The second patient, a case of diabetic nephropathy on maintenance hemodialysis, developed CRBSI due to S. maltophilia, which initially responded to catheter removal and levofloxacin but was later complicated dramatically by pneumonia and enteritis with colonic ulcers. These cases highlight the variable clinical presentation of this organism and emphasize the need for active surveillance in the dialysis unit.
Insights
Two hemodialysis patients developed Stenotrophomonas maltophilia bloodstream infections. These cases show varied clinical presentations, highlighting the need for active surveillance in dialysis units to manage this resistant bacterium.
Area of Science:
- Infectious Diseases
- Nephrology
- Critical Care Medicine
Background:
- Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in hemodialysis patients.
- Stenotrophomonas maltophilia is a highly resistant, gram-negative nosocomial pathogen frequently implicated in healthcare-associated infections.
Observation:
- Two hemodialysis patients presented with CRBSI caused by S. maltophilia.
- The first patient, with primary hyperoxaluria, showed a favorable response to catheter removal and levofloxacin.
- The second patient, with diabetic nephropathy, experienced initial improvement but later developed severe pneumonia and enteritis with colonic ulcers.
Findings:
- S. maltophilia can present with variable clinical manifestations in hemodialysis patients.
- Successful treatment of S. maltophilia CRBSI may depend on the patient's underlying condition and the extent of infection.
- The organism's resistance profile necessitates careful antibiotic selection and management strategies.
Implications:
- These cases underscore the importance of vigilant surveillance for S. maltophilia in dialysis units.
- Early recognition and appropriate management are crucial to prevent severe complications associated with S. maltophilia infections.
- Further research into optimal treatment protocols for S. maltophilia CRBSI in immunocompromised populations is warranted.
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