Clinicomicrobiological profile of patients with Stenotrophomonas maltophilia infections.

INTRODUCTION

Stenotrophomonas maltophilia is an emerging nosocomial pathogen associated with severe infections in critically ill patients and limited therapeutic options due to intrinsic antimicrobial resistance. Indian data describing its clinical spectrum, resistance patterns, and outcomes remain scarce.

METHODS

A retrospective observational study was conducted at a tertiary care center in northern India between January 2021-June 2022. Adult patients (≥18 years) with culture-confirmed S. maltophilia infection were included. Only hospital-acquired infections were included. Data on demographics, comorbidities, clinical severity (SOFA, APACHE II), prior antibiotic exposure, and ICU parameters were collected. Microbiological details (source, susceptibility per CLSI guidelines), treatment regimens, resistance profiles, and clinical outcomes (14-day cure, oxygen/vasopressor requirement, mortality) were analyzed.

RESULTS

Among 53 patients with Stenotrophomonas maltophilia isolates, 38 (71.7%) had true infections. Median age was 33.5 years (IQR 26-51.5); 68.4% were male. Bloodstream infection was most common (73.7%), followed by hospital/ventilator-associated pneumonia (26.3%). Diabetes (31.6%) and chronic kidney disease (23.7%) were the main comorbidities. Prior carbapenem (63.2%) and glycopeptide (42.1%) use was frequent. Susceptibility remained high to minocycline (86.8%), levofloxacin (86.8%), and cotrimoxazole (84.2%). Pneumonia, higher SOFA scores, vasopressor use, and minocycline resistance were associated with poor outcomes, with a mortality rate of 52.6%.

CONCLUSION

S. maltophilia infections in critically ill patients carry a high mortality despite susceptibility to standard agents. Early recognition, optimal antimicrobial choice, and supportive care are crucial for improving outcomes.