Stenotrophomonas maltophilia Outbreak in an ICU: Investigation of Possible Routes of Transmission and Implementation of Infection Control Measures

Pathogens. 2024 Apr 29;13(5):369. doi: 10.3390/pathogens13050369.

Abstract

Stenotrophomonas maltophilia, a non-fermentative, ubiquitous, gram-negative aerobic bacterium, is associated with high mortality rates, particularly in immunocompromised or debilitated patients. The prevalence rate of ICU-acquired pneumonia episodes caused by this microorganism has been found to be 2%. S. maltophilia has been identified as one of the top 10 microorganisms responsible for such infections in EU/EEA countries. This study describes an outbreak of S. maltophilia in an intensive care unit of a hospital in northern Italy. This includes an epidemiological investigation of the cases, the environmental microbiological controls carried out, a comparison of the strains by multilocus sequence typing (MLST), and the measures taken to prevent and control the outbreak. Among the seven clinical isolates of S. maltophilia analyzed herein, six demonstrated susceptibilities to trimethoprim-sulfamethoxazole. Conversely, one isolate of S. maltophilia exhibited resistance to first-line antibiotics. ST was found to be identical for six patients (ST 4), as well as in the environmental feedback on the trolley of Box 2. The analysis of the temporal and spatial progression of the outbreak has suggested that the transmission of S. maltophilia may have occurred through cross-transmission during care practices.

Keywords: ICU; MLST; S. maltophilia; outbreak.

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Cross Infection* / epidemiology
  • Cross Infection* / microbiology
  • Cross Infection* / prevention & control
  • Cross Infection* / transmission
  • Disease Outbreaks* / prevention & control
  • Female
  • Gram-Negative Bacterial Infections* / epidemiology
  • Gram-Negative Bacterial Infections* / microbiology
  • Gram-Negative Bacterial Infections* / prevention & control
  • Gram-Negative Bacterial Infections* / transmission
  • Humans
  • Infection Control* / methods
  • Intensive Care Units*
  • Italy / epidemiology
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Multilocus Sequence Typing*
  • Stenotrophomonas maltophilia* / drug effects
  • Stenotrophomonas maltophilia* / isolation & purification
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Trimethoprim, Sulfamethoxazole Drug Combination