The clinical features of stenotrophomonas maltophili infection in children
10.3760/cma.j.issn.1673-4912.2024.05.003
- VernacularTitle:儿童嗜麦芽窄食单胞菌感染临床特征分析
- Author:
Yuanjie ZHOU
1
;
Nan SHEN
;
Bailu DU
;
Weichun HUANG
;
Qing CAO
;
Lijuan LUO
Author Information
1. 上海交通大学医学院附属上海儿童医学中心感染科 200127
- Keywords:
Children;
Stenotrophomonas maltophilia;
Clinical characteristic
- From:
Chinese Pediatric Emergency Medicine
2024;31(5):333-336
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To understand the clinical characteristics of stenotrophomonas maltophilia（SMA）infections in pediatric patients.Methods:This was a retrospective observational study.The children diagnosed with SMA infections between January 2018 and June 2023 at Shanghai Children's Medical Center were selected as the study population.The clinical characteristics of patients were analyzed.According to the outcome,the patients were categorized into survival and death groups to compare the clinical characteristics.Results:A total of 70 patients were included in the study,including 23 females and 47 males,with an onset age of 9.0 (3.0,12.6) years old.Sixty-five (92.9%) patients had underlying malignancies，primarily hematologic and solid tumors,of which 24(34.3%) cases underwent bone marrow hematopoietic stem cell transplantation,and 18(25.7%) cases underwent chimeric antigen receptor T cell immunotherapy (CAR-T).Forty (57.1%) cases of SMA infection sites were respiratory infections,19 (27.1%) cases were bloodstream infections,and 11 (15.7%) cases were soft tissue infections.Prior to infection，33（47.14%）patients were treated with glucocorticoids and 63（90.0%）patients with carbapenems.Eventually，39（55.7%）patients were discharged,while 31 patients died,with a mortality rate of 44.3%.Minocycline（100.0%），levofloxacin（98.1%），co-trimoxazole（96.2%），and cefoperazone/sulbactam（94.0%）showed high sensitivity rates to SMA.Compared with the survival group,the death group had a younger age [11.9 (8.4,13.8) years vs.6.3 (2.1,10.0) years],longer hospitalization before infection and duration after stem cell transplantation [28 (23,46) d vs.25 (16,34) d,140 (93，221) d vs.24 (12,49) d],and a higher proportion of pre-infection ICU admission,pre-infection glucocorticoids usage,receiving CAR-T treatment and lymphoma as the underlying disease [26 (83.9%) cases vs.15 (38.46%) cases,22 (71.0%) cases vs.11 (28.2%) cases,13 (41.9%) cases vs.5(12.8%) cases,11（35.5%）cases vs.3（7.7%）cases],and the differences were all statistically significant ( P<0.05). Conclusion:SMA infection pose a serious risk to pediatric patients with malignancies,compromised immune systems and exposured to broad-spectrum antibiotics.SMA maintains excellent sensitivity to compound sulfamethoxazole，minocycline，levofloxacin，and cefoperazone/sulbactam in pediatric patients.The mortality rate of SMA infection is very high，with longer pre-infection hospitalization，pre-infection ICU admission，pre-infection glucocorticoids usage，older onset age，longer duration after stem cell transplantation,receiving CAR-T treatment and lymphoma as the underlying disease possibly associated with post infection mortality
