Bloodstream infection caused by Stenotrophomonas maltophilia in children.

BACKGROUND: Stenotrophomonas maltophilia, a multidrug resistant Gram-negative pathogen, has become a more frequent cause of bloodstream infections (BSI). Little is known about development of S. maltophilia bacteremia in children. The objective of this study was to define risk factors and outcomes associated with S. maltophilia BSI in children.

METHODS: This was a retrospective case-control study conducted at The Children's Hospital of Philadelphia between January 1, 2000 and July 31, 2005. All patients with S. maltophilia BSI were compared with a random sample of patients with non-Stenotrophomonas Gram-negative rod BSI.

RESULTS: Fifty-one cases and 103 control subjects were included in the study. The median patient age was 2 years (interquartile range: 1 day-8.5 years). Patients with S. maltophilia BSI were significantly more likely to have a malignancy and be coinfected with other organisms than those with other Gram-negative rod infections. On multivariate analysis, patients with S. maltophilia BSI were more likely to develop their infection in the home setting (adjusted OR, 4.18; 95% CI: 1.44-12.16; P = 0.009). Additionally, prior exposure to trimethoprim-sulfamethoxazole, receipt of steroids or other immunosuppressive medication in the 30 days preceding infection and black race were associated with the development of S. maltophilia BSI.

CONCLUSIONS: Patients with Stenotrophomonas maltophilia BSI are more likely to have a polymicrobial infection and develop their infection in the home setting compared with patients with BSI caused by other Gram-negative rods.