Extended multidrug-resistant Stenotrophomonas maltophilia septicemia in a severely burnt patient.

摘要

Multidrug-resistant Stenotrophomonas maltophilia septicemia in the literature of burns is rare and rapidly fatal. We report a case of extended multidrug-resistant S. maltophilia septicemia in a burn patient, highlighting the need for vigilance, time-critical appropriate antimicrobial therapy, and a return to older antimicrobials. Our patient, an 18-year-old previously healthy female, suffered 41% partial thickness flame burns in a road traffic accident; the flames were extinguished by rolling on mud. After a significant transfer distance, operative debridement, early excision and staged grafting were performed. On post-burn day 21, she suddenly developed hyperpyrexia and severe deterioration. Acute renal and myocardial failure, endotoxic shock, and near arrest followed within 3 hours despite "best-guess" treatment (mero-penem, gentamicin, and teicoplanin therapy). Swinging hyperpyrexia (38-42.5degC), severe refractoryleukemoid reaction, and thrombocytopenia ensued. S. maltophilia was cultured from an arterial line, resistant to an extensive antimicrobial spectrum including aminoglyco-side, carbapenem, peptidoglycan, and oxacephems, only moderately sensitive to cotrimoxazole, and sensitive to colistin. Immediate intravenous polymyxin-E and cotrimoxazole administrations were followed by rapid improvement.