Stenotrophomonas maltophilia in Hemodialysis: An Opportunistic Pathogen or a Malevolent Foe

Catheter-related bloodstream infections (CRBSIs) add to the morbidity and mortality of hemodialysis patients. <i>Stenotrophomonas maltophilia</i> is an extremely resistant, gram-negative, non-lactose-fermenting nosocomial bacterium that contributes significantly to mortality and morbidity. This bacterium is predominantly associated with community-acquired pneumonia, bacteremia, eye afflictions, biliary sepsis, urinary tract infection, skin and soft tissue infection, and very rarely chronic enteritis with colonic ulcers. Here, we present two cases that presented indolently and exhibit strikingly contrasting behaviors. The first case was a patient with primary hyperoxaluria on maintenance hemodialysis, who presented with CRBSI due to <i>S. maltophilia</i>, which responded appropriately to catheter removal and levofloxacin. The second patient, a case of diabetic nephropathy on maintenance hemodialysis, developed CRBSI due to <i>S. maltophilia</i>, which initially responded to catheter removal and levofloxacin but was later complicated dramatically by pneumonia and enteritis with colonic ulcers. These cases highlight the variable clinical presentation of this organism and emphasize the need for active surveillance in the dialysis unit.