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Stenotrophomonas (Xanthomonas) maltophilia Urinary Tract Infection: A Disease That Is Usually Severe and Complicated

Stenotrophomonas (Xanthomonas) maltophilia Urinary Tract Infection: A Disease That Is Usually... Abstract Background: Stenotrophomonas (Xanthomonas) maltophilia has emerged as a causative agent of serious nosocomial infections. However, well-documented cases of urinary tract infection with this organism have rarely been reported. Methods: Review of the medical records of patients admitted to a large cancer center with cultures yielding S maltophilia from urinary sources during a 15-month period. Results: All urinary tract infections were serious: 13 were complicated and two were acute uncomplicated pyelonephritis. The urinary tracts of 13 other patients were colonized with S maltophilia. Most of the colonized and infected patients were hospitalized with genitourinary malignancy, underwent urinary catheterization, and were receiving antibiotics inactive against S maltophilia. Neutropenia and urinary structural abnormalities were significantly associated with infection. The clinical course of infection was usually severe: fever (100%), sepsis disorder (47%), neutrophilia (70% of patients without neutropenia), bacteremia (13%), and death (7%). Still, response to treatment was prompt. Conclusions: Stenotrophomonas maltophilia urinary tract infection is usually associated with a severe clinical course. Risk factors for urinary colonization by this organism include hospitalization, urinary catheterization, and administration of inactive antibiotics. Risk factors for urinary tract infection include neutropenia and urinary structural abnormalities. In the presence of these risk factors, treatment for S maltophilia should be considered in patients with urinary colonization by the organism or in those with nosocomial urinary tract infection caused by an unknown pathogen and that is unresponsive to therapy with the antibiotics that are used to treat the common uropathogens.(Arch Intern Med. 1996;156:433-435) References 1. Marshall WF, Keating MR, Anhalt JP, Steckelberg JM. Xanthomonas maltophilia: an emerging nosocomial pathogen . Mayo Clin Proc. 1989;64:1097-1104.Crossref 2. Gilardi GL. Pseudomonas maltophilia infections in man . Am J Clin Pathol. 1969; 51:58-61. 3. Zuravleff JJ, Yu VL. Infections caused by Pseudomonas maltophilia with emphasis on bacteremia: case reports and a review of the literature . Rev Infect Dis. 1982;4:1236-1246.Crossref 4. Wishart MW, Riley TV. Infection with Pseudomonas maltophilia: hospital outbreak due to contaminated disinfectant . Med J Aust. 1976;2:710-712. 5. Khardori N, Elting L, Wong E, Schable B, Bodey GP. Nosocomial infections due to Xanthomonas maltophilia (Pseudomonas maltophilia) in patients with cancer . Rev Infect Dis. 1990;12:997-1003.Crossref 6. McDonald GR and Pernenkil R. Community-acquired Xanthomonas maltophilia pyelonephritis . South Med J. 1993;86:967-968.Crossref 7. Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE. Evaluation of new anti-infective drugs for the treatment of urinary tract infection . Clin Infect Dis. 1992;15( (suppl 1) ):S216-S227.Crossref 8. Kunin CM. Urinary tract infections in females . Clin Infect Dis. 1994;18:1-12.Crossref 9. Bone RC. Sepsis, the sepsis syndrome, multiorgan failure: a plea for comparable definitions . Ann Intern Med. 1991;114:332-333.Crossref 10. Vartivarian S, Anaissie E, Bodey G, Sprigg H, Rolston K. A changing pattern of susceptibility of Xanthomonas maltophilia to antimicrobial agents: implications for therapy . Antimicrob Agents Chemother. 1994;38:624-627.Crossref 11. Vartivarian SE, Papadakis KA, Palacios JA, Manning JT, Anaissie EJ. Mucocutaneous and soft tissue infections caused by Xanthomonas maltophilia: a new spectrum . Ann Intern Med. 1994;121:969-973.Crossref 12. Papadakis KA, Vartivarian, SE, Anaissie EJ, Samonis G. Xanthomonas maltophilia bacteremia in cancer patients: an analysis of 44 episodes . Clin Infect Dis. 1994;19:588. Abstract 149. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Stenotrophomonas (Xanthomonas) maltophilia Urinary Tract Infection: A Disease That Is Usually Severe and Complicated

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References (12)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1996.00440040111012
Publisher site
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Abstract

Abstract Background: Stenotrophomonas (Xanthomonas) maltophilia has emerged as a causative agent of serious nosocomial infections. However, well-documented cases of urinary tract infection with this organism have rarely been reported. Methods: Review of the medical records of patients admitted to a large cancer center with cultures yielding S maltophilia from urinary sources during a 15-month period. Results: All urinary tract infections were serious: 13 were complicated and two were acute uncomplicated pyelonephritis. The urinary tracts of 13 other patients were colonized with S maltophilia. Most of the colonized and infected patients were hospitalized with genitourinary malignancy, underwent urinary catheterization, and were receiving antibiotics inactive against S maltophilia. Neutropenia and urinary structural abnormalities were significantly associated with infection. The clinical course of infection was usually severe: fever (100%), sepsis disorder (47%), neutrophilia (70% of patients without neutropenia), bacteremia (13%), and death (7%). Still, response to treatment was prompt. Conclusions: Stenotrophomonas maltophilia urinary tract infection is usually associated with a severe clinical course. Risk factors for urinary colonization by this organism include hospitalization, urinary catheterization, and administration of inactive antibiotics. Risk factors for urinary tract infection include neutropenia and urinary structural abnormalities. In the presence of these risk factors, treatment for S maltophilia should be considered in patients with urinary colonization by the organism or in those with nosocomial urinary tract infection caused by an unknown pathogen and that is unresponsive to therapy with the antibiotics that are used to treat the common uropathogens.(Arch Intern Med. 1996;156:433-435) References 1. Marshall WF, Keating MR, Anhalt JP, Steckelberg JM. Xanthomonas maltophilia: an emerging nosocomial pathogen . Mayo Clin Proc. 1989;64:1097-1104.Crossref 2. Gilardi GL. Pseudomonas maltophilia infections in man . Am J Clin Pathol. 1969; 51:58-61. 3. Zuravleff JJ, Yu VL. Infections caused by Pseudomonas maltophilia with emphasis on bacteremia: case reports and a review of the literature . Rev Infect Dis. 1982;4:1236-1246.Crossref 4. Wishart MW, Riley TV. Infection with Pseudomonas maltophilia: hospital outbreak due to contaminated disinfectant . Med J Aust. 1976;2:710-712. 5. Khardori N, Elting L, Wong E, Schable B, Bodey GP. Nosocomial infections due to Xanthomonas maltophilia (Pseudomonas maltophilia) in patients with cancer . Rev Infect Dis. 1990;12:997-1003.Crossref 6. McDonald GR and Pernenkil R. Community-acquired Xanthomonas maltophilia pyelonephritis . South Med J. 1993;86:967-968.Crossref 7. Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE. Evaluation of new anti-infective drugs for the treatment of urinary tract infection . Clin Infect Dis. 1992;15( (suppl 1) ):S216-S227.Crossref 8. Kunin CM. Urinary tract infections in females . Clin Infect Dis. 1994;18:1-12.Crossref 9. Bone RC. Sepsis, the sepsis syndrome, multiorgan failure: a plea for comparable definitions . Ann Intern Med. 1991;114:332-333.Crossref 10. Vartivarian S, Anaissie E, Bodey G, Sprigg H, Rolston K. A changing pattern of susceptibility of Xanthomonas maltophilia to antimicrobial agents: implications for therapy . Antimicrob Agents Chemother. 1994;38:624-627.Crossref 11. Vartivarian SE, Papadakis KA, Palacios JA, Manning JT, Anaissie EJ. Mucocutaneous and soft tissue infections caused by Xanthomonas maltophilia: a new spectrum . Ann Intern Med. 1994;121:969-973.Crossref 12. Papadakis KA, Vartivarian, SE, Anaissie EJ, Samonis G. Xanthomonas maltophilia bacteremia in cancer patients: an analysis of 44 episodes . Clin Infect Dis. 1994;19:588. Abstract 149.

Journal

Archives of Internal Medicine – American Medical Association

Published: Feb 26, 1996

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