Stenotrophomonas (Xanthomonas) maltophilia Urinary Tract Infection

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Abstract
Background: Stenotrophomonas (Xanthomonas) maltophiliahas 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 yieldingS maltophiliafrom 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 withS maltophilia. Most of the colonized and infected patients were hospitalized with genitourinary malignancy, underwent urinary catheterization, and were receiving antibiotics inactive againstS 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 maltophiliaurinary 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 forS maltophiliashould 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)