Context: Stenotrophomonas maltophilia is a known nosocomial pathogen which is intrinsically resistant to multiple antibiotics. In India, S. maltophilia infection has only few case reports.
Aim: To determine the incidence of S. maltophilia infection from clinical isolates based on the specimen type, antibiotic susceptibility pattern, and impact on outcome.
Settings and Design: One-year retrospective study was done at a tertiary liver care center.
Methods: Patients with S. maltophilia isolation in clinical samples were selected. Serial levels of serum procalcitonin and total leukocyte count were recorded. Environmental surveillance was done from the wards of S. maltophilia isolation as part of routine practice.
Statistical Analysis: Continuous data were compared using Kruskal–Wallis test/Mann–Whitney test. The categorical data were compared by Chi-square/Fisher's exact test, wherever necessary. Besides this, an appropriate analysis like survival was carried out at the time of data analysis.
Results: One hundred isolates were obtained from eighty patients of six wards. The greatest number (44/100, 44%) were from the Liver Coma Intensive Care Unit and the lowest (3/100) from the day care. Isolation from the respiratory samples was 1.32% and bloodstream infection 0.6%. Of 100 isolates, 12 (12%) were resistant to both trimethoprim–sulfamethoxazole and levofloxacin.
Conclusion: S. maltophilia was effectively isolated from the hospital environment, with two of hand impression and three of water samples' positive. Patients with respiratory infection had most S. maltophilia isolates. Antibiotic susceptibility revealed more resistance than reported in this region.
Safdar A. Stenotrophomonas maltophilia and Burkholderia cepacia. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier/Saunders; 2015. p. 2532-40.
Marzuillo C, De Giusti M, Tufi D, Giordano A, Del Cimmuto A, Quattrucci S, et al. Molecular characterization of Stenotrophomonas maltophilia isolates from cystic fibrosis patients and the hospital environment. Infect Control Hosp Epidemiol 2009;30:753-8.
Cervia JS, Ortolano GA, Canonica FP. Hospital tap water as a source of Stenotrophomonas maltophilia infection. Clin Infect Dis 2008;46:1485-7.
Paopradit P, Srinitiwarawong K, Ingviya N, Singkhamanan K, Vuddhakul V. Distribution and characterization of Stenotrophomonas maltophilia isolates from environmental and clinical samples in Thailand. J Hosp Infect 2017;97:185-91.
Looney WJ, Narita M, Mühlemann K. Stenotrophomonas maltophilia: An emerging opportunist human pathogen. Lancet Infect Dis 2009;9:312-23.
Brooke JS. Stenotrophomonas maltophilia: An emerging global opportunistic pathogen. Clin Microbiol Rev 2012;25:2-41.
Thomas J, Prabhu VN, Varaprasad IR, Agrawal S, Narsimulu G. Stenotrophomonas maltophilia: A very rare cause of tropical pyomyositis. Int J Rheum Dis 2010;13:89-90.
Chawla K, Vishwanath S, Munim FC. Nonfermenting gram-negative bacilli other than Pseudomonas aeruginosa and Acinetobacter spp. causing respiratory tract infections in a tertiary care center. J Glob Infect Dis 2013;5:144-8.
Chhablani J, Sudhalkar A, Jindal A, Das T, Motukupally SR, Sharma S, et al. Stenotrophomonas maltophilia endogenous endophthalmitis: Clinical presentation, antibiotic susceptibility, and outcomes. Clin Ophthalmol 2014;8:1523-6.
Kataria A, Lata S, Khillan V. Hemodialysis catheter-related bacteremia caused by Stenotrophomonas maltophilia. Indian J Nephrol 2015;25:318-9.
Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American thoracic society. Clin Infect Dis 2016;63:e61-e111.
Ooms L, IJzermans J, Voor In 't Holt A, Betjes M, Vos M, Terkivatan T, et al. Urinary tract infections after kidney transplantation: A risk factor analysis of 417 patients. Ann Transplant 2017;22:402-8.
Batra P, Mathur P, Misra MC. Clinical characteristics and prognostic factors of patients with Stenotrophomonas maltophilia infections. J Lab Physicians 2017;9:132-5.
Mukhopadhyay C, Vishwanath S, Eshwara VK, Shankaranarayana SA, Sagir A. Microbial quality of well water from rural and urban households in Karnataka, India: A cross-sectional study. J Infect Public Health 2012;5:257-62.
Mahapatra A, Padhi N, Mahapatra D, Bhatt M, Sahoo D, Jena S, et al. Study of biofilm in bacteria from water pipelines. J Clin Diagn Res 2015;9:DC09-11.
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. M100-S27. Wayne, PA: CLSI; 2017.
WHO. Public Health Importance of Antimicrobial Resistance; 2000. Available from: http://www.who.int/drugresistance/AMR_Importance/en/. [Last accessed on 2018 Feb 23].
Cabaret O, Bonnal C, Canoui-Poitrine F, Emirian A, Bizouard G, Levesque E, et al. Concomitant presence of Aspergillus fumigatus and Stenotrophomonas maltophilia in the respiratory tract: A new risk for patients with liver disease? J Med Microbiol 2016;65:414-9.
Gauna TT, Oshiro E, Luzio YC, Paniago AM, Pontes ER, Chang MR, et al. Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-Western Brazil. Rev Soc Bras Med Trop 2013;46:426-32.
Sawai T, Yoshioka S, Matsuo N, Suyama N, Mukae H. Intraabdominal abscess caused by Stenotrophomonas maltophilia: A case report. Int J Surg Case Rep 2017;41:212-4.
Harada K, Sekiya N, Konishi T, Nagata A, Yamada Y, Takezaki T, et al. Predictive implications of albumin and C-reactive protein for progression to pneumonia and poor prognosis in Stenotrophomonas maltophilia bacteremia following allogeneic hematopoietic stem cell transplantation. BMC Infect Dis 2017;17:638.
Gallo SW, Figueiredo TP, Bessa MC, Pagnussatti VE, Ferreira CA, Oliveira SD, et al. Isolation and characterization of Stenotrophomonas maltophilia isolates from a Brazilian hospital. Microb Drug Resist 2016;22:688-95.
Sah R, Siwakoti S, Baral R, Rajbhandari RS, Khanal B. Stenotrophomonas maltophilia causing blood stream infection in neonates and infants: A cause for concern. Trop Doct 2017;1:49475517743360.[Epub ahead of print].