Stenotrophomonas maltophilia infections in intensive care units: a prospective and international ID-IRI study

INTRODUCTION: Stenotrophomonas maltophilia (S. Maltophilia) is a multidrug-resistant pathogen causing severe infections in intensive care units (ICUs). This study aimed to identify the risk factors influencing 30-day mortality and evaluate antimicrobial susceptibility patterns in ICU patients with S. maltophilia infections. METHODOLOGY: A prospective, multicenter, international observational study was conducted between 15 October 2023 and 15 April 2024, in 36 ICUs across 12 countries. Adult patients (≥ 18 years) with S. maltophilia isolated from blood, urine, or respiratory cultures were included if isolates were considered clinically consistent with infection. Colonized or coinfected patients were excluded. Clinical, laboratory data were collected prospectively. Thirty-day outcome was defined as survival or death after the first positive culture. RESULTS: A total of 207 patients were included; 109 (52.7%) died within 30 days. The primary infection sites were pneumonia (28.5%) and bloodstream infections (38.0%). Resistance rates were 7.2% for trimethoprim-sulfamethoxazole (TMP-SMX), 10.4% for levofloxacin, and 27% for ceftazidime. None of the patients received effective empiric therapy. Older age (p = 0.030), acute renal failure (p = 0.016), chronic obstructive pulmonary disease (COPD; p = 0.008), malignancy (p = 0.001), and sequential organ failure assessment (qSOFA) ≥ 2 (p = 0.001) were independently associated with higher mortality. Repeat culturing and antimicrobial modification according to susceptibility testing reduced mortality (p = 0.017). CONCLUSIONS: S. maltophilia remains a lethal ICU pathogen. Early risk assessment, cultures, susceptibility testing, and therapy changes are vital. TMP-SMX and levofloxacin stay effective; but surveillance, infection control, and prudent antibiotic use remain essential.

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Journal
The Journal of Infection in Developing Countries
Published
2026-03-31
DOI
https://doi.org/10.3855/jidc.22056
Primary Topic
Infections and bacterial resistance
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article
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article

Stenotrophomonas maltophilia infections in intensive care units: a prospective and international ID-IRI study

Şafak Özer Balın, Hakan Evren, Bülent Durdu, Meltem Taşbakan et al.
The Journal of Infection in Developing Countries
Infections and bacterial resistance
article

Stenotrophomonas maltophilia infections in intensive care units: a prospective and international ID-IRI study

Şafak Özer Balın, Hakan Evren, Bülent Durdu, Meltem Taşbakan, Ayşe Sağmak Tartar, G.A. Utepbergenova, Meltem KARSLIOĞLU, Gülden Eser Karlıdağ, Hülya Çaşkurlu, Rusmir Baljić, İlknur Şenel, Serkan Öncü, Özlem Aldemir, Fatma Çölkesen, Yasemin Çağ, Yurdagül Albayrak, Yeşim Aybar Bilir, Tarsila Vieceli, Nirav Pandya, Maha Ali Gad, Hakan Erdem, Esra Gürbüz, Alper Tahmaz, Abdullah Umut Pekok, Özlem Alıcı, Bilal Ahmad Rahimi, Handan Ankaralı, Mustafa Serhat ŞAHİNOĞLU, LUCA Cătălina, İlknur Erdem, Arzu Şenol, Pınar Yürük Atasoy, Ramesh Shankar Ganeshan, Anna Líšková, Rositsa Tanova, Amani El-Kholy, Merve Sarı, Fahad Almajid, Irina M Dumitru, Halenur Vural Akbal, Ahmed Almessabi, Gökhan Vatansever, Ferda İnal Yılmaz, Mehmet Özdemir, Fatma Amer, Chavdar Stefanov, Maya Belitova, Gergana Lengerova, Sevil Alkan
article en

Abstract

INTRODUCTION: Stenotrophomonas maltophilia (S. Maltophilia) is a multidrug-resistant pathogen causing severe infections in intensive care units (ICUs). This study aimed to identify the risk factors influencing 30-day mortality and evaluate antimicrobial susceptibility patterns in ICU patients with S. maltophilia infections. METHODOLOGY: A prospective, multicenter, international observational study was conducted between 15 October 2023 and 15 April 2024, in 36 ICUs across 12 countries. Adult patients (≥ 18 years) with S. maltophilia isolated from blood, urine, or respiratory cultures were included if isolates were considered clinically consistent with infection. Colonized or coinfected patients were excluded. Clinical, laboratory data were collected prospectively. Thirty-day outcome was defined as survival or death after the first positive culture. RESULTS: A total of 207 patients were included; 109 (52.7%) died within 30 days. The primary infection sites were pneumonia (28.5%) and bloodstream infections (38.0%). Resistance rates were 7.2% for trimethoprim-sulfamethoxazole (TMP-SMX), 10.4% for levofloxacin, and 27% for ceftazidime. None of the patients received effective empiric therapy. Older age (p = 0.030), acute renal failure (p = 0.016), chronic obstructive pulmonary disease (COPD; p = 0.008), malignancy (p = 0.001), and sequential organ failure assessment (qSOFA) ≥ 2 (p = 0.001) were independently associated with higher mortality. Repeat culturing and antimicrobial modification according to susceptibility testing reduced mortality (p = 0.017). CONCLUSIONS: S. maltophilia remains a lethal ICU pathogen. Early risk assessment, cultures, susceptibility testing, and therapy changes are vital. TMP-SMX and levofloxacin stay effective; but surveillance, infection control, and prudent antibiotic use remain essential.

The Journal of Infection in Developing CountriesVol. 20(03)
Yeditepe University (TR), University of Sarajevo (BA), Çanakkale Onsekiz Mart Üniversitesi (TR), Tekirdağ Namık Kemal University (TR), Slovak University of Agriculture in Nitra (SK), Cairo University (EG), Giresun University (TR), Ovidius University (RO), Manisa Celal Bayar University (TR), Zagazig University (EG), Medical University Plovdiv (BG), Queen Giovanna Hospital (BG), Ahmet Yesevi University (KZ), King Saud University (SA), Bezmiâlem Vakıf Üniversitesi (TR), Kandahar University (AF), Ege University (TR), Konya Numune Hastanesi (TR), Gülhane Askerî Tıp Akademisi (TR), Sheikh Shakhbout Medical City (AE), St.Caridad Hospital (BG), Hospital de Clínicas de Porto Alegre (BR), Memorial Ankara Hospital (TR), University Hospital St. Ivan Rilski (BG), Necmettin Erbakan University (TR), Sivas State Hospital (TR), Antalya Eğitim ve Araştırma Hastanesi (TR), Institute of Plant Genetics and Biotechnology of the Slovak Academy of Sciences (SK), Samsun University (TR), Animal Production Research Centre (SK), Education Training And Research (US), Başkent University Hospital (TR), Sağlık Bilimleri Üniversitesi (TR), Infectious Clinical Hospital No. 1 (RU), Elazığ Eğitim ve Araştırma Hastanesi (TR), Nethradhama Superspeciality Eye Hospital (IN), University of Kyrenia (CY), Istanbul Medeniyet University (TR), Istanbul University (TR), Adnan Menderes University (TR)
Good health and well-being
Openalex Percentile: Top 20%
Infections and bacterial resistance
DOIOpen Access PDFOpenAlex
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