title: Bloodstream infection caused by Stenotrophomonas maltophilia in children.
abstract: BACKGROUND
  Stenotrophomonas maltophilia, a multidrug resistant Gram-negative pathogen, has become a more frequent cause of bloodstream infections (BSI). Little is known about development of S. maltophilia bacteremia in children. The objective of this study was to define risk factors and outcomes associated with S. maltophilia BSI in children.
  
  
  METHODS
  This was a retrospective case-control study conducted at The Children's Hospital of Philadelphia between January 1, 2000 and July 31, 2005. All patients with S. maltophilia BSI were compared with a random sample of patients with non-Stenotrophomonas Gram-negative rod BSI.
  
  
  RESULTS
  Fifty-one cases and 103 control subjects were included in the study. The median patient age was 2 years (interquartile range: 1 day-8.5 years). Patients with S. maltophilia BSI were significantly more likely to have a malignancy and be coinfected with other organisms than those with other Gram-negative rod infections. On multivariate analysis, patients with S. maltophilia BSI were more likely to develop their infection in the home setting (adjusted OR, 4.18; 95% CI: 1.44-12.16; P = 0.009). Additionally, prior exposure to trimethoprim-sulfamethoxazole, receipt of steroids or other immunosuppressive medication in the 30 days preceding infection and black race were associated with the development of S. maltophilia BSI.
  
  
  CONCLUSIONS
  Patients with Stenotrophomonas maltophilia BSI are more likely to have a polymicrobial infection and develop their infection in the home setting compared with patients with BSI caused by other Gram-negative rods.
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, PA 19104, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kagen
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.forename: Karin L
authors.initials: KL
authors.lastname: McGowan
authors.forename: Xianqun
authors.initials: X
authors.lastname: Luan
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D001741:Black or African American; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D015143:Philadelphia; D012189:Retrospective Studies; D012307:Risk Factors; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification*; D013256:Steroids / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D015662:Trimethoprim, Sulfamethoxazole Drug Combination