Case Reports
Fulminant Stenotrophomonas maltophilia Soft Tissue Infection in Immunocompromised Patients: An Outbreak Transmitted via Tap Water

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ABSTRACT

Soft tissue infection caused by Stenotrophomonas maltophilia is uncommon, but nosocomial infections had been reported. We describe herein 2 young female patients, with severe neutropenia, on broad spectrum antimicrobial agents for neutropenic fever, with Hickman-type central venous catheter, who developed mucocutaneous and soft tissue infections with rapidly progressive and devastating course. Cultures from the skin of both patients and from blood of one of them grew S maltophilia. Both patients died and post mortem examination of the patient with S maltophilia bacteremia revealed extensive soft tissue necrosis and a vegetation on the mitral valve that grew S maltophilia. The infection occurred in both patients at the same time and in the same ward. Epidemiological study was done, and surveillance cultures grew the organism from the faucets from the room of 1 patient and also from some of the neighboring rooms in our ward but not from any other ward nor in the water reservoir of the building.

Section snippets

Case 1

A 31-year-old woman was admitted with fever, fatigue, and perianal pain of 1 week’s duration. Physical examination revealed a markedly pale patient without dyspnea or jaundice. Her temperature was 38°C, her blood pressure normal, and her heart rate was 110 beats/min. Her physical examination was normal except for hemorrhoids. Laboratory studies revealed leucocytosis of 35,300/mm3 with 89% blasts and 3% neutrophiles, hemoglobin of 8.4 g/dL, and platelet count of 351,000/mm3. Bone marrow biopsy and

Discussion

S maltophilia is increasingly recognized as an important pathogen causing nosocomial infections. A number of nosocomial outbreaks had been reported in the last years.6., 8., 9., 30., 31. Khardori et al6 reported an increased rate of isolation of S maltophilia in patients with cancer. From December 1985 to May 1986, 52 isolates of the organism were recovered from cultures of clinical specimens from 38 patients; case records were available for 35 of the 38 patients. Of these, 18 patients had a

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