Treatment refractoryStenotrophomonas maltophiliabacteraemia and pneumonia in a COVID-19-positive patient

Abstract

Stenotrophomonas maltophilia is an opportunistic pathogen that most often infects patients requiring mechanical ventilation, indwelling central venous catheters and broad-spectrum antibiotics. The reported incidence of S. maltophilia infection has increased over the past two decades, and many of its risk factors are commonly seen in patients with severe COVID-19 infection. Our case regards a patient with severe COVID-19 pneumonia, who subsequently developed disseminated S. maltophilia infection, refractory to first-line treatment and optimal medical management. This case highlights the high index of suspicion required for diagnosing secondary complications in patients with COVID-19 infection and highlights the difficulty in treating disseminated S. maltophilia infection in critically ill patients.

Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review

“…Among these, Stenotrophomonas maltophilia should be considered a pathogen of interest due to its limited treatment options [63] and the fact that it typically infects patients with ongoing prolonged mechanical ventilation and extensive exposure to antibiotics [64]. Additionally, reports of S. maltophilia were particularly frequent in highly immunocompromised patients [65] or subjects with particularly complicated clinical courses with multiple subsequent secondary infections and severe lung failure [66]. Yet, S. maltophilia represents more often an opportunistic pathogen, rather than a "simple" causative agent of nosocomial infection, suggesting the need of a high index of suspicion.…”

Stenotrophomonas maltophilia Bacteremia Associated With Severe COVID-19: Successful Treatment With Appropriate Antimicrobial Therapy

“…In the present case, we confirmed the organism's susceptibility to TMP-SMX; prompt administration of this antibiotic combination led to a good outcome. Notably, our patient was about 10 years younger than the one reported by Pek et al [7], and improvements in the treatment of COVID-19 since they treated their patient may have contributed to our patient's good outcome.…”

“…We present a rare case of bacteremia caused by S. maltophilia during severe COVID-19 infection. Only one case of bacteremia caused by S. maltophilia has been reported in a patient with severe COVID-19, and that patient ultimately died [7]. In the present case, S. maltophilia bacteremia during severe COVID-19 was successfully treated with antimicrobial therapy.…”

Efficacy in Galleria mellonella Larvae and Application Potential Assessment of a New Bacteriophage BUCT700 Extensively Lyse Stenotrophomonas maltophilia

“…The risk of S. maltophilia infections mediated by the medical devices is exacerbated with an increase in the number of ICU patients during the Corona Virus Disease 2019 (COVID-19) epidemic ( 13 ). There have been 12 cases of coinfection with S. maltophilia and COVID-19 reported in the research ( 16 ). In addition, the most essential factor contributing to the serious infections and high mortality of S. maltophilia is its intrinsic resistance to clinically used antibiotics such as penicillins, cephalosporins, carbapenems, aminoglycosides, and macrolides ( 6 ).…”