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Stenotrophomonas (Xanthomonas) maltophilia urinary tract infection. A disease that is usually severe and complicated
S E Vartivarian1, K A Papadakis, E J Anaissie
1Department of Medical Specialties, University of Texas M. D. Anderson Center, Houston, USA.
Background:
Stenotrophomonas (Xanthomonas) maltophilia has emerged as a causative agent of serious nosocomial infections. However, well-documented cases of urinary tract infection with this organism have rarely been reported.
Methods:
review of the medical records of patients admitted to a large cancer center with cultures yielding S maltophilia from urinary sources during a 15-month period.
Results:
All urinary tract infections were serious: 13 were complicated and two were acute uncomplicated pyelonephritis. The urinary tracts of 13 other patients were colonized with S maltophilia. Most of the colonized and infected patients were hospitalized with genitourinary malignancy, underwent urinary catheterization, and were receiving antibiotics inactive against S maltophilia. Neutropenia and urinary structural abnormalities were significantly associated with infection. The clinical course of infection was usually severe: fever (100%), sepsis disorder (47%), neutrophilia (70% of patients without neutropenia), bacteremia (13%) and death (7%). Still, response to treatment was prompt.
Conclusions:
Stenotrophomonas maltophilia urinary tract infection is usually associated with a severe clinical course. Risk factors for urinary colonization by this organism include hospitalization, urinary catheterization, and administration of inactive antibiotics. Risk factors for urinary tract infection include neutropenia and urinary structural abnormalities. In the presence of these risk factors, treatment of S maltophilia should be considered in patients with urinary colonization by the organism or in those with nosocomial urinary tract infection caused by an unknown pathogen and that is unresponsive to therapy with the antibiotics that are used to treat the common uropathogens.
Insights
Stenotrophomonas maltophilia causes severe urinary tract infections, especially in hospitalized patients with risk factors like catheterization. Prompt treatment is crucial for these serious nosocomial infections.
Area of Science:
- Infectious Diseases
- Urology
- Medical Microbiology
Background:
- Stenotrophomonas maltophilia is an emerging cause of severe nosocomial infections.
- Documented cases of S. maltophilia urinary tract infections (UTIs) are rare.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of S. maltophilia UTIs.
- To identify risk factors for S. maltophilia colonization and infection in the urinary tract.
Main Methods:
- Retrospective review of medical records.
- Analysis of patients with S. maltophilia isolated from urinary sources over 15 months at a cancer center.
Main Results:
- All UTIs were serious (complicated or pyelonephritis).
- Risk factors for colonization included hospitalization, urinary catheterization, and inactive antibiotics.
- Neutropenia and urinary structural abnormalities were linked to infection.
- Severe clinical course observed: fever, sepsis, bacteremia, with a 7% mortality rate.
- Prompt response to treatment was noted.
Conclusions:
- S. maltophilia UTIs typically present with a severe clinical course.
- Hospitalization, catheterization, and inactive antibiotics are risk factors for colonization.
- Neutropenia and urinary abnormalities increase infection risk.
- Consider S. maltophilia treatment for colonized patients or those with unresponsive nosocomial UTIs.