Risk Factors for Infection and Mortality Associated With Stenotrophomonas maltophilia Bloodstream Infections in Children; Comparison With Pseudomonas aeruginosa Bloodstream Infections

Abstract

Introduction: The increasing incidence of Stenotrophomonas maltophilia (S. maltophilia) infections raises concern because of the high fatality/case ratio. This study aimed to evaluate the risk factors for infection and mortality associated with S. maltophilia bloodstream infections (BSIs) in children and compare them with Pseudomonas aeruginosa BSIs. Methods: All BSIs caused by S. maltophilia (n:73) and P. aeruginosa (n:80) were enrolled in this study between January 2014 and December 2021 at the Medical School of Ege University. Results: Previous Pediatric Intensive Care Unit (PICU) admission, prior glycopeptide, and carbapenem use were significantly more common in patients with S. maltophilia BSIs (P = 0.044, P = 0.009, and P = 0.001, respectively) than with P. aeruginosa BSIs. C-reactive protein (CRP) levels were significantly higher in S. maltophilia BSIs (P = 0.002). Multivariate analysis showed that prior carbapenem use was associated with S. maltophilia BSIs (P = 0.014, adjusted odds ratio [AOR]: 2.710; 95% confidence interval [CI]: 1.225–5.992). PICU admission because of BSI, prior carbapenem and glycopeptide use, neutropenia, and thrombocytopenia were significantly more common in patients with mortality because of S. maltophilia BSIs (P < 0.001, P = 0.010, P = 0.007, P = 0.008, P = 0.004, respectively), while only PICU admission because of BSI, and prior glycopeptide use were significant in multivariate analysis (AOR, 19.155; 95% CI: 2.337–157.018; P = 0.006 and AOR, 9.629; 95% CI: 1.053–88.013; P = 0.045, respectively). Conclusion: Prior carbapenem use is a significant risk factor for developing S. maltophilia BSIs. PICU admission because of BSI and prior glycopeptide use are risk factors associated with the mortality rate in patients with S. maltophilia BSIs. Therefore, S. maltophilia should be considered in patients with these risk factors, and empirical treatment should include antibiotics for S. maltophilia.