Stenotrophomonas maltophilia, though commonly reported as an opportunistic respiratory pathogen, has been known to cause a wide variety of illnesses, including urinary tract infection, biliary sepsis, bacteremia, and osteomyelitis. Malignancy and immunocompromised states are the biggest risk factors associated with Stenotrophomonas maltophilia infection. Being an emerging nosocomial infection globally, the bacteria should no longer be considered as just a mere colonizer, and emphasis should be laid on understanding the mechanisms of resistance, modes of prevention, and treatment. We present the case of an 89-year-old Haitian American male with a past medical history of prostate adenocarcinoma and urinary retention following transurethral resection of the prostate, requiring an indwelling urinary catheter who presented to the emergency department with poorly draining Foley, hematuria, and urinary retention associated with suprapubic pain. Laboratory investigations revealed elevated creatinine, and urine analysis was suggestive of infection. The patient was admitted for the treatment of complicated urinary tract infection and acute kidney injury in the setting of urinary retention. Urine culture and sensitivity results revealed Stenotrophomonas maltophilia sensitive to trimethoprim/sulfamethoxazole, to which the patient responded well. During the course of the patient's hospital stay, his kidney function gradually improved. We also present the case of a 68-year-old female with a past medical history of chronic tracheostomy dependence who presented to the emergency department for worsening fatigue and copious secretions from tracheostomy. Chest X-ray was suggestive of consolidation/edema, and the patient got admitted under the impression of septic encephalopathy due to pneumonia in a patient with tracheostomy. The patient received appropriate antibiotic therapy, and her mental status improved. However, the patient late developed respiratory distress, tachycardia, and tachypnea with worsening right-sided infiltrates on chest X-ray. The patient was started on vancomycin and cefepime for possible aspiration pneumonia. Cefepime was later changed to meropenem. Sputum culture and sensitivity results grew Stenotrophomonas maltophilia sensitive to meropenem which was continued. The patient's clinical status, laboratory and imaging findings improved over the course of her hospital stay.

Stenotrophomonas maltophilia, a gram-negative bacillus well known to cause respiratory tract infections, is increasingly being reported to cause urinary tract infections (UTI). In our review of the literature comprising six articles, males were more prone to developing UTIs, with the mean age of the patients being 62.5 ±18.9 years. While several risk factors have been associated with the development of the disease, patients with underlying urological or nephrological diseases tend to develop a more severe illness. The organism was sensitive to trimethoprim-sulfamethoxazole (TMP-SMX) in the majority of cases. This systematic review also aims to shed light on the possible mechanisms of resistance adopted by the bacteria, modes of transmission, and strategies to prevent the transmission and development of the disease.

Hypophosphatemia is among the most common electrolyte abnormalities, especially among patients with underlying malignancies, and is frequently associated with adverse prognoses. Phosphorus levels are regulated through a number of mechanisms, including parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), vitamin D, and other electrolyte levels themselves. Clinically, the findings are nonspecific, and the diagnosis is frequently delayed. This article is a narrative literature review. The PubMed database was searched for relevant articles pertaining to hypophosphatemia causes and consequences in patients suffering from multiple myeloma. We found a variety of causes of hypophosphatemia in patients with multiple myeloma. Tumor-induced osteopenia, although more common among patients with small squamous cell carcinomas, can occur with multiple myeloma as well. Additionally, both light chains themselves and medications can trigger Fanconi syndrome, which leads to phosphorus wasting by the kidney. Bisphosphonates, in addition to being a possible cause of Fanconi syndrome, lead to a decrease in calcium levels, which then stimulates parathyroid hormone (PTH) release, predisposing the patient to significant hypophosphatemia. Additionally, many of the more modern medications used to manage multiple myeloma have been associated with hypophosphatemia. A better understanding of those mechanisms may give clinicians a clearer idea of which patients may need more frequent screening as well as what the potential triggers in the individual patient may be.