Prevalence and antimicrobial susceptibility pattern of Stenotrophomonas maltophilia isolated from peritoneal fluid cultures of dialysis patients
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262623Keywords:
Catheter removal, Diabetes mellitus, Peritoneal dialysis, Peritonitis, Stenotrophomonas maltophiliaAbstract
Background: Stenotrophomonas maltophilia (S. maltophilia) is an important cause of nosocomial infections, particularly in immunocompromised patients, such as patients with indwelling catheters. Blood stream infections are a leading cause of morbidity among patients undergoing dialysis. Prevalence and Antimicrobial Susceptibility pattern of Stenotrophomonas maltophilia isolated from peritoneal fluid cultures of Dialysis Patients.
Methods: This single-center, retrospective, case–control study was conducted between April 2025 and January 2026. Patients who were undergoing dialysis at a tertiary care hospital, south Kerala and were diagnosed with S. maltophilia were included in this study. The demographic data, clinical characteristics and initial treatment data of the patients were analyzed to determine the risk factors for peritoneal dialysis- related S. maltophilia peritonitis.
Results: A total of 370 peritonitis cases were recorded during the study period. Seven patients with S. maltophilia peritonitis and 21 controls (three controls to one case) were included in this study. The incidence of S. maltophilia peritonitis was significantly more frequent among patients with diabetes mellitus compared with controls (80.0% vs. 20.0%, p=0.004) and among patients with higher white blood cell counts in the dialysate after appropriate antibiotic therapy 2561/µl (349–4654/µl) vs. 20/µl (20–23/µ), p<0.001) than among the control patients. Although all the patients were treated with appropriate antibiotics following the identification of S. maltophilia, they had a significantly higher rate of catheter removal than the controls (80.0% vs. 0.0%, p=0.0003).
Conclusions: Diabetes mellitus may be an important risk factor for S. maltophilia peritonitis in patients undergoing peritoneal dialysis.
References
Garrison MW, Anderson DE, Campbell DM, Carroll KC, Malone CL, Anderson JD, et al. Stenotrophomonas maltophilia: emergence of multidrug-resistant strains during therapy and in an in vitro pharmacodynamic chamber model. Antimicrob Agents Chemother. 1996;40(12):2859–64.
Ribera A, Jurado A, Ruiz J, Marco F, Del Valle O, Mensa J, et al. In vitro activity of clinafloxacin in comparison with other quinolones against Stenotrophomonas maltophilia clinical isolates in the presence and absence of reserpine. Diagn Microbiol Infect Dis. 2002;42(2):123–8.
Pankuch GA, Jacobs MR, Rittenhouse SF, Appelbaum PC. Susceptibilities of 123 strains of stenotropomonas maltophilia to eight β-lactams (including β-lactam–β-lactamase inhibitor combinations) and ciprofloxacin tested by five methods. Antimicrob Agents Chemother. 1994;38(10):2317-22.
Vartivarian SE, Anaissie EJ, Bodey GP, Sprigg HA, Rolston KVI. A changing pattern of susceptibility of stenotropomonas maltophilia to antimicrobial agents: implications for therapy. Antimicrob Agents Chemother. 1994;38(3):624-7.
Nicodemo AC, Garcia Paez JI. Antimicrobial therapy for Stenotrophomonas maltophilia infections. Eur J Clin Microbiol Infect Dis. 2007;26(4):229-37.
Samonis G, Karageorgopoulos DE, Maraki S, Levis P, Dimopoulou D, Spernovasilis NA, et al. Stenotrophomonas maltophilia infections in a general hospital: patient characteristics, antimicrobial susceptibility and treatment outcome. PLoS One. 2012;7(5):37375.
Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev. 2012;25(1):2–41.
Looney WJ, Narita M, Mühlemann K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis. 2009;9(5):312–23.
Szeto CC, Chow KM, Leung CB. Clinical course of peritonitis due to Stenotrophomonas maltophilia. Am J Kidney Dis. 2006; 48(4):41–5.
Li PKT, Szeto CC, Piraino B. ISPD peritonitis recommendations: 2016 update. Perit Dial Int. 2016;36(5):481–508.
Cho Y, Johnson DW. Peritoneal dialysis-related peritonitis: towards improving evidence, practices and outcomes. Am J Kidney Dis. 2014;64(2):278–89.
Kato S, Chmielewski M, Honda H. Aspects of immune dysfunction in end-stage renal disease. Clin J Am Soc Nephrol. 2008;3(5):1526–33.
Wang AY, Yu AW, Li PK. Factor’s predicting outcome of fungal peritonitis in peritoneal dialysis: a review of 20 cases. Am J Kidney Dis. 2000;36(6):1183–9.
Gales AC, Jones RN, Forward KR, Linares J, Sader HS, Verhoef J. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY Antimicrobial Surveillance Program (1997–1999). Clin Infect Dis. 2001;32(2):104-13.
Pa W. Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing: 20th informational supplement. CLSI document M100-S20. 2010.
Cho SY, Kang CI, Chung DR, Peck KR, Song JH. Treatment outcomes of Stenotrophomonas maltophilia bacteremia. Antimicrobial Agents and Chemotherapy. 2014;58(1):176–82.
Falagas ME, Kastoris AC, Vouloumanou EK, Dimopoulos G. Attributable mortality of Stenotrophomonas maltophilia infections: systematic review. Future Microbiol. 2009; 4(9):1103–9.
Abbott IJ, Peleg AY. Stenotrophomonas, Achromobacter and nonmelioid Burkholderia species. Clinical Microbiology Reviews. 2015;28(2):475–503.
Gezer Y, Tayşi MR, Tarakçı A. Evaluation of clinical outcomes and risk factors associated with mortality in patients with Stenotrophomonas maltophilia infection: a multicenter study. BMC Infect Dis. 2024;24:1387.
Takami J, Nakano Y, Harada E. Recurrent peritoneal dialysis-related peritonitis caused by Stenotrophomonas maltophilia. Ren Replace Ther. 2024;10:43.
Kim S, Ji S, Cho D. Persistence of Stenotrophomonas maltophilia in bacteraemia. Microorganisms. 2024;12(1):423.