Stenotrophomonas maltophilia Infections in Infants: A Case Series from an Indian Neonatal and Pediatric Intensive Care Unit

Introduction: Stenotrophomonas maltophilia, a Gram-negative, multidrug-resistant bacterium, is an emerging cause of hospital-acquired infections, particularly in immunocompromised pediatric patients. Its resistance to multiple antibiotics complicates therapeutic management, contributing to significant morbidity and mortality. This case series examines the risk factors and management strategies for S. maltophilia infections in a Neonatal and Pediatric Intensive Care Unit (NICU/PICU). Methods: A retrospective case series was conducted involving four infants (aged ۱–۴ months) admitted to the NICU or PICU at a tertiary care hospital in upper Assam, India, from January to December ۲۰۲۳. Clinical data, risk factors, antibiotic susceptibility, treatments, and outcomes were analyzed with parental consent. Results: All patients presented with sepsis, three with pneumonia and two with suspected meningitis. Risk factors included prematurity (n=۲), low birth weight (n=۲), mechanical ventilation (n=۲), and prior antibiotic exposure (n=۴). Blood cultures confirmed S. maltophilia, resistant to empirical antibiotics (ciprofloxacin, gentamicin) but isolates were susceptible to levofloxacin (n=۴) and minocycline (n=۴); two were also susceptible to trimethoprim-sulfamethoxazole (TMP-SMX) (n=۲). Treatment with levofloxacin (۱۴–۲۱ days; n=۳) or oral TMP-SMX (۱۰ days; n=۱) resulted in recovery in three patients with minimal residual sequelae. One patient died post-discharge after being readmitted for severe respiratory distress; the definitive cause of death was unknown. Conclusion: Tailored antibiotic therapy guided by susceptibility testing was associated with improved outcomes in S. maltophilia infections, despite multidrug resistance. Prematurity and mechanical ventilation were identified as key risk factors, highlighting the need for infection control and judicious antibiotic use.

کلیدواژه ها:

Stenotrophomonas maltophilia ، Multidrug-resistant infections ، Neonates ، NICU/PICU ، Antibiotic resistance ، Sepsis