Combo therapy extends survival in paediatric ICU patients with S. maltophilia infection
Critically ill children harbouring Stenotrophomonas maltophilia in the intensive care unit (ICU) may benefit from the combination treatment of trimethoprim and sulfamethoxazole, ciprofloxacin, and minocycline, suggests a recent study.
“Meticulous evaluation of central vascular access and prior treatment with carbapenems are indicated, especially for mechanically ventilated and septic children,” the investigators said.
The study identified and reviewed 31 patients and 91 isolates from blood, respiratory secretions and soft tissues. During the study period, an increase in the overall incidence of S. maltophilia infections was observed (p=0.003). There was a 61-percent all-cause crude mortality, while the attributed mortality was approximately 16 percent.
The following risk factors were associated with mortality: longer hospitalization before infection (p=0.002), septic shock (p=0.003), mechanical ventilation (p=0.004), an indwelling central vein catheter (p=0.03) and prior use of steroids (p=0.04) and carbapenems (p=0.004).
Multivariate analysis revealed the association of mortality with mechanical ventilation (p=0.02) and preinfection hospitalization days (p=0.01). Combination treatment of trimethoprim and sulfamethoxazole, ciprofloxacin and/or minocycline significantly extended survival time (p<0.001). The treatment method did not significantly affect the interval between S. maltophilia isolation to resolution of infection (p=0.2).
In this study, a retrospective chart review was conducted involving paediatric patients with isolates of S. maltophilia hospitalized over a 5-year period in two paediatric ICUs.
“S. maltophilia is a life-threatening nosocomial pathogen with profound multidrug-resistant attributes. It is associated with high mortality, particularly in immunocompromised patients. Data on therapy for S. maltophilia infections are scarce, especially in children hospitalized in intensive care settings (paediatric ICU),” the investigators said.