Article in Japanese

A boy with meningitis caused by Stenotrophomonas maltophilia after long-term antimicrobial use

Akito HORIKAWA¹⁾, Hiroshi OKADA¹⁾

Stenotrophomonas maltophilia is a multidrug-resistant Gram-negative bacillus, and intensive care management, prior broad-spectrum antimicrobial therapy and neurosurgery increase the risk of developing infection from this organism. This paper reports a case of meningitis caused by S. maltophilia after severe head trauma followed by multiple neurosurgical procedures and prolonged antimicrobial use. The case was a 5-year-old boy. He had undergone emergency craniotomy for severe head trauma at 4 years and 2 months of age and had undergone repeated neurosurgical procedures to manage continuous intraventricular hemorrhage and hydrocephalus. During the treatment, he developed meningitis caused by Staphylococcus epidermidis and a catheter-related urinary tract infection. S. maltophilia was detected in his cerebrospinal fluid culture at the age of 5 years and 3 months, and he was treated with linezolid and ceftazidime with no improvement. Then, he was transferred to this hospital because of repeated relapses after the catheter device was replaced. After the transfer, he was treated with trimethoprim sulfamethoxazole and minocycline, and after removal of the residual foreign body and replacement of the device, his cerebrospinal fluid culture was negative, and he did not relapse. Although meningitis caused by S. maltophilia is rare, it should be assumed that it is caused by an organism with risk factors. Trimethoprim sulfamethoxazole is the first-line agent of antimicrobial therapy. When disease occurs, it is important to administer the appropriate antimicrobial as soon as possible and remove unnecessary devices such as catheters.

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1) Department of Pediatrics, Matsudo City General Hospital Children's Medical Centre

Key words	Stenotrophomonas maltophilia, meningitis
Received	September 12, 2020
Accepted	March 1, 2020

33 (2)：107─112,2021