Stenotrophomonas maltophilia Meningitis - A Case Series and Review of the Literature

Abstract

Stenotrophomonas maltophilia is an infrequent cause of acute bacterial meningitis and only a few cases have been reported in the literature. Infection is associated with morbidity and mortality, and its optimal management remains ill-defined. The aim of the current study is to review the management of S. maltophilia meningitis. We described two cases of S. maltophilia meningitis following neurosurgical procedures. The first patient was a 60-year-old female. She was admitted to the hospital with a left basal ganglia bleed and underwent placement of an external ventricular drain for the treatment of hydrocephalus. She developed S. maltophilia meningitis 20 days after surgery. She was successfully treated with a combination of trimethoprimsulfamethoxazole and intravenous colistin and the removal of the drain. She successfully underwent a ventriculoperitoneal (VP) shunt placement at the therapeutic midway point. The second patient was a 35year-old male with a history of intracranial aneurysm bleeding. He had undergone a craniotomy and placement of a ventriculoperitoneal shunt two years previously. His shunt was replaced twice due to blockage. The last replacement had occurred 15 days prior to the development of meningitis. He was treated with a combination of trimethoprim-sulfamethoxazole and ceftazidime (as well as undergoing another shunt replacement) and experienced an excellent recovery. S. maltophilia is a rare but important cause of nosocomial meningitis. It is strongly associated with prior hospitalization and neurosurgical intervention, which is also found in our case series. The management of S. maltophilia meningitis is a therapeutic challenge due to its high resistance to multiple antibiotics. Optimal therapy is based on antimicrobial sensitivity, and the trimethoprim-sulfamethoxazole-based combination has been shown to be successful. The duration of therapy is debatable, but like most gram-negative meningitis infections, therapy lasting up to three weeks appears to be adequate.

Stenotrophomonas maltophilia as a rare cause of meningitis and ventriculoperitoneal shunt infection

“…Khanum et al . reviewed 30 cases of S. maltophilia meningitis in 2020 [ 5 ]. In addition to this we could identify five more cases of S. maltophilia meningitis [ 4, 6, 8, 9 ].…”

“…There were a total of 24 implants in these 22 patients. These include ten (42 %) EVD, nine (37 %) VP shunt, three (13 %) ommaya reservoir, one (4 %) aqueduct stent and one (4 %) aneurysm clip [1,[3][4][5][6][7][8][9]. Of the 35 cases reported six (17 %) patients succumbed to death.…”

“…We report a case of VP shunt infection and meningitis caused by S. maltophilia in a 24-year-old female who presented with VP shunt dysfunction and migration of the distal end of the shunt tube into the bowel. So far only 35 cases of S. maltophilia meningitis have been reported in the literature [1,[3][4][5][6][7][8][9]. The intention of this article is to present this rare case and to briefly review the relevant literature.…”

“…So far only 35 cases of S. maltophilia meningitis have been reported in the literature [1, 3–9]. The intention of this article is to present this rare case and to briefly review the relevant literature.…”

Stenotrophomonas maltophilia as a Cause of Meningitis in an Infant

“…CA infections due to S. maltophilia are uncommon and occur in those with comorbidities and the immunocompromised [1,2]. There is only one published case of CA meningitis in a healthy term neonate [3].…”