We present Stenotrophomonas maltophilia infections in 317 hospitalized patients in a large health network over a 3-year period. The majority of patients were elderly. Most infections were polymicrobial: respiratory 95.2%, wound 91%, urinary 80.8% and blood 64.3%. Younger patients were small in number and were more common in those with otitis externa, infections from injection drug use and those with line infections. Most deaths were in patients with terminal conditions and polymicrobial infections and mortality could not be directly attributed to Stenotrophomonas maltophilia. None of the sputum, bronchial, urinary or wound culture positive patients had positive blood cultures. Only blood (14/317) or ear (7/317) culture positive patients had significant numbers of younger individuals with only 3 out of 14 over age 50 in blood culture positive patients and 1/7 in those with otitis externa. Those with bacteremia included patients with injection drug use, chronic pain syndromes and vascular catheter infections. 94% of urinary infections, 91.7% wound infections and 85.8% respiratory isolates were in those above age 50. Overwhelming majority of urinary infections were in males with drainage devices present in 75%. Recurrent infections were uncommon. Respiratory specimens were frequently associated with tracheostomies and endotracheal tubes. Most wound infections were in chronic lower extremity ulcers. Prior carbapenem use was not significant in this study. Isolates from all sites were over 98% susceptible to Trimethoprim/sulphamethoxazole. Limitations: The study group only had 1 organ transplant and 2 cystic fibrosis patients and no burn wound infections.

Although the definition of polypharmacy has evolved over time, it has been and remains to be an issue in healthcare. With the prevalence of polypharmacy increasing, those in the health care field must remain vigilant of the adverse effects of medications and work to coordinate care and maintain appropriate prescribing practices. Here we present a clinical vignette that describes an encounter of a patient on multiple medications and the individual, provider, and systems-level issues that may have contributed to an adverse event resulting in a hospital stay. We will discuss the definition of polypharmacy, review the prevalence and economic implications of drug prescription practices, and examine the consequences and complications of polypharmacy in a number of different patient populations. We will discuss a number of scenarios involving polypharmacy that lead to medication errors, decreased quality of life, and patient harm, and then review evidencebased methods of interventions aimed at reducing the prevalence of polypharmacy and its associated complications.

The term Munchausen syndrome is used to describe a situation where a person inflicts an illness or injury on self. Munchausen syndrome by proxy is when a person fabricates an illness on behalf of another. We report the case of an injection drug user admitted to the hospital for a spinal epidural abscess which was drained, treated with antibiotics and doing well, suddenly becoming very sick and febrile on day 17. The blood cultures grew a total of 12 organisms including 2 fungi. Someone who visited the patient in the hospital around this time was suspected to have injected a solution of drugs brought from home directly into the patient’s intravenous line used to administer antibiotics resulting in a polymicrobial bacteremia/fungemia. Presence of Lactobacilli in one blood culture raised the suspicion that the girl friend who was also a drug user, may have been responsible as Lactobacilli are more frequently found in hands of females. We caution physicians and nurses to be vigilant when handling injection drug users and other drug abusers admitted to hospital. Materials brought to the patient’s room from outside must be screened. New onset of unexpected symptoms should alert caregivers of the possibility of such abuse.