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Cocuk Sagligi ve Hastaliklari Dergisi, vol.47, no.1, pp.23-29, 2004 (Scopus)
We report our experience with Stenotrophomonas maltophilia isolations in 26 newborns in whom Stenotrophomonas maltophilia isolates were recovered in any of the blood, urine, tracheal aspirate, or cerebrospinal. fluid cultures, and discuss the clinical, bacteriologic, and epidemiologic features of Stenotrophomonas maltophilia infection or colonization in the newborn. The incidence of Stenotrophomonas maltophilia isolation was 1.4% in a total of 1, 824 newborns hospitalized. Mean gestational age of the newborns was 29.8 ± 3.8 weeks, mean birth weight was 1360 ± 790 g, and the mean postnatal age, at which Stenotrophomonas maltophilia isolates were recovered, was 11.7 ± 9.7 days. Twenty-five of the newborns had prematurity and related complications as the primary diagnoses; one had both prematurity and alveolocapillary dysplasia. The only newborn at term had hypoxic-ischemic encephalopathy resulting from perinatal asphyxia. All the patients had been given a combination of broad-spectrum antimicrobial therapy in the last two weeks prior to the isolation of Stenotrophomonas maltophilia. Invasive procedures as other possible risk factors associated with acquisition of Stenotrophomonas maltophilia were endotracheal intubation and mechanical ventilation and central catheterization in all (100%) patients. The duration of mechanical ventilation in the patients varied between three to 48 days. Of the 26 newborns with a Stenotrophomonas maltophilia isolation, 15 died, and the overall mortality rate was 57.7%. The mortality rate attributable to Stenotrophomonas maltophilia was 15.4% considering the simultaneous isolation of Stenotrophomonas maltophilia from the blood and contribution of the Stenotrophomonas maltophilia infection to death in four cases. The great majority of Stenotrophomonas maltophilia isolates were from the respiratory tract. Regarding the antibiotic sensitivity patterns of Stenotrophomonas maltophilia isolates, all but one were sensitive to at least one antibiotic, ciprofloxacin. Antibiotics should be used judiciously, and prolonged intubation and use of central catheters should be avoided in the newborn since the overall and attributable mortality rates due to Stenotrophomonas maltophilia are significantly high. It seems reasonable that all culture positivities of Stenotrophomonas maltophilia in the newborn should be considered as "true infection" and treated with effective antibiotics since the differentiation of colonization from infection is not always easy and may be risky, and furthermore because most of the antibiotics commonly used in clinical practice are not effective against Stenotrophomonas maltophilia. The peculiar microbiologic characteristics of Stenotrophomonas maltophilia, including its multiresistant phenotype and antibiotic sensitivity pattern, should be considered when managing either true- or pseudo-infection in critically ill newborns.