Stenotrophomonas maltophilia Infections in Pediatric Patients – Experience at a European Center for Pediatric Hematology and Oncology

Abstract

Stenotrophomonas maltophilia is an important nosocomial pathogen in immunocom-promised individuals and characterized by intrinsic resistance to broad-spectrum antibacterial agents. Limited data exists on its clinical relevance in immunocompromised pediatric patients, particularly those with hematological or oncological disorders. In a retrospective single center cohort study in pediatric patients receiving care at a large european pediatric hematology and oncology department, ten cases of invasive S.maltophilia infections (blood stream infections (BSI), 4; BSI and pneumonia, 3, or soft tissue infection, 2; and pneumonia, 1) were identified between 2010 and 2020. Seven patients had lymphoblastic leukemia and/or were post allogeneic hematopoietic cell transplantation. Invasive S.maltophilia infections occurred in a setting of indwelling central venous catheters, granulocytopenia, defective mucocutaneous barriers, treatment with broad-spectrum antibacterial agents, and admission to the intensive care unit. Whole genome sequencing based typing revealed no genetic relationship among four individual S.maltophilia isolates. The case fatality rate and mortality at 100 days post diagnosis were 40 and 50%, respectively, and three patients died from pulmonary hemorrhage. Invasive S.maltophilia infections are an emerging cause of infectious morbidity in patients receiving care at departments of pediatric hematology and oncology and carry a high case fatality rate.

Case Series: Stenotrophomonas maltophilia in Pediatric Oncology Patients

“…All of our patients were pancytopenic and severely immunosuppressed, all with refractory or relapsed leukemias, two patients and two patients had received HSCT and one was post-treatment for HLH. Few cases of necrotizing skin and soft tissue infections similar to our first 2 patients have been reported 3,4 . Curiously, our first patient had the same mixed phenotype leukemia as the first adult immunocompromised patient to succumb to S. maltophilia necrotizing fasciitis in the Western hemisphere reported in 2018 5 .…”

Epidemiologic and clinical characteristics of human bocavirus infection in children hospitalized for acute respiratory tract infection in Qingdao, China

“…It is necessary to combine factors, such as clinical manifestations and medical history characteristics, to determine whether the positive PCR result is caused by contamination, colonization, or pathogenic microorganisms (He et al, 2012 ). Stenotrophomonas maltophilia has been recognized in recent studies as an important nosocomial pathogen in immunocompromised and critically ill patients (De and Zhao, 2020 ; Nantachit et al, 2021 ; Zöllner et al, 2021 ) and as an important pathogen of hospital-acquired infections (Liu et al, 2018b ; Wang et al, 2018 ). It is often isolated during invasive consultations (Liu et al, 2018a ).…”

Bloodstream Infections in Pediatric Oncology Patients: Bacterial Pathogen Distribution and Antimicrobial Susceptibility at the University Hospital Centre Zagreb, Croatia—A 5-Year Analysis

“…It is important to notice that there were 3 S. maltophilia isolates (2.8%) present with 2 of them resistant to TMP-SXT, traditionally regarded as the drug of choice for S. maltophilia infections. Recent studies report the frequency of S. maltophilia among BSI isolates in pediatric hematology/oncology patients ranging from 1.2% to 4.8% 16,17,19,20,36 . The strains resistant to TMP-SXT may be selected by the use of intermittent doses of TMP-SXT used for anti- Pneumocystis prophylaxis.…”