Jiang ZhiHong, Ren YiFan, Zhang ChuanXin, Yin Yu, Li ChaoHui
Department of Paediatrics, ShaoXing KeQiao Women And Children's Hospital, ShaoXing, Zhejiang Province, People's Republic of China.
Infect Drug Resist. 2022 Sep 19;15:5469-5474. doi: 10.2147/IDR.S376712. eCollection 2022.
Stenotrophomonas maltophilia (S. maltophilia) is a pathogen causing opportunistic and nosocomial infections that are invasive and fatal, especially in hospitalized and immunocompromised patients. However, community-acquired S. maltophilia is rarely reported in children with normal immunity. S. maltophilia is a multi-drug-resistant bacterium, and the preferred drug is trimethoprim/sulfamethoxazole (TMP/SMX), which has greater side effects in children.
Herein, we reported the case of a child with clinical manifestations of fever, high C-reactive protein (CRP) and white blood cells, and severe pneumonia. The blood culture yielded S. maltophilia. The initial treatment regimen was meropenem IV, which was subsequently changed to ceftazidime IV, and finally to oral cefixime, which has less side effects in children. The child recovered completely. At the 1-month follow-up, anteroposterior chest X-ray was normal, and the child was in good general health.
Although community-acquired S. maltophilia infection in children is rare, it can occur. The doctor encountered such a child in clinical work. This child has a normal immune system, his disease comes from a community infection and has lobar pneumonia located in the lower lung area. At the same time, the child's white blood cells and CRP values are high, the doctor should be concerned that the child may have S. maltophilia infection. When treating patients, doctors can try to use drugs empirically, such as ceftazidime, instead of using ciprofloxacin, SMZ and other drugs that have relatively large side effects in children. It is worth mentioning that doctors also need to adjust the medication in a timely manner according to the efficacy evaluation and drug sensitivity of the children after the medication, so as to minimize the drug resistance of community-acquired infections. This will prevent the misuse of Meropenem, which has been given in a community patient and that too in a child. Its important to prevent this malpractise.
嗜麦芽窄食单胞菌是一种可引发机会性感染和医院感染的病原体，具有侵袭性且可致命，尤其在住院患者和免疫功能低下患者中。然而，免疫功能正常的儿童社区获得性嗜麦芽窄食单胞菌感染鲜有报道。嗜麦芽窄食单胞菌是一种多重耐药菌，首选药物是甲氧苄啶/磺胺甲恶唑（TMP/SMX），但该药物对儿童副作用较大。
在此，我们报告一例儿童病例，其临床表现为发热、高C反应蛋白（CRP）和白细胞计数，以及严重肺炎。血培养检出嗜麦芽窄食单胞菌。初始治疗方案为静脉注射美罗培南，随后改为静脉注射头孢他啶，最后改为口服头孢克肟，后者对儿童副作用较小。该患儿完全康复。在1个月的随访中，胸部前后位X线片正常，患儿总体健康状况良好。
尽管儿童社区获得性嗜麦芽窄食单胞菌感染罕见，但仍有可能发生。医生在临床工作中会遇到此类患儿。该患儿免疫系统正常，其疾病源于社区感染，且患有位于下肺区域的大叶性肺炎。同时，患儿白细胞和CRP值较高，医生应警惕患儿可能感染嗜麦芽窄食单胞菌。在治疗患者时，医生可尝试经验性用药，如头孢他啶，而非使用在儿童中副作用相对较大的环丙沙星、磺胺甲恶唑等药物。值得一提的是，医生还需根据患儿用药后的疗效评估和药敏情况及时调整用药，以尽量减少社区获得性感染的耐药性。这将避免在社区患者尤其是儿童中滥用美罗培南。防止这种不当做法很重要。
