Characteristics of Stenotrophomonas maltophilia bacteremia in children

Background Empiric antimicrobial coverage in compromised hosts commonly includes pseudomonal coverage but often lacks coverage against Stenotrophomonas maltophilia . Identification of risk factors specific for S . maltophilia infection may lead to prompt initiation of appropriate antibiotics and improved outcome. Methods We conducted a retrospective analysis of pediatric patients with bacteremia due to S . maltophilia or Pseudomonas aeruginosa from April 2002 to July 2014 at a tertiary children's hospital. Patient demographics, underlying disease, clinical course, and treatment were compared between S . maltophilia and P . aeruginosa cases. Results Nineteen children with S . maltophilia bacteremia and 49 children with P . aeruginosa bacteremia were identified. On multivariate logistic regression analysis, use of carbapenems within 7 days prior to onset (OR, 5.00; 95%CI: 1.25–20.07; P  = 0.02) and previous intensive care unit stay (OR, 3.75; 95%CI: 1.13–12.47; P  = 0.03) were significantly associated with S . maltophilia bacteremia compared with P . aeruginosa bacteremia. The majority of the S . maltophilia bacteremia patients had central line‐associated bloodstream infection (79%), compared with the P . aeruginosa bacteremia patients (37%, P  = 0.002). There were nine children (47%) who had polymicrobial infection in the S . maltophilia bacteremia group, in contrast to four (8%) in the P . aeruginosa bacteremia group (OR, 10.13; 95%CI: 2.59–39.56; P  = 0.001). Consultation with an infectious diseases physician was associated with a lower rate of persistent S . maltophilia bacteremia ( P  = 0.04). Conclusions Stenotrophomonas maltophilia should be considered in breakthrough bacteremia in pediatric patients who receive carbapenems within 7 days prior to onset.