Arif Maqsood Ali, Ayaz Hussain Qureshi, Shahid Rafi.
Stenotrophomonas Maltophilia septicemia in a patient with Nosocomial Pneumonia.
Pak J Pathol Jan ;13(2):44-6.

A seventy years old man admitted with right sided inguinal hernia for 2 months. He was a chronic "Hukka" smoker for more than 40 years and had history of chronic cough. On examination, he was emaciated and weak but well oriented. There was a reducible right-sided direct inguinal hernia and hydrocoele. The patient was investigated and was placed on operation list for planned surgery. On 1st Feb, 2002 the patient developed low grade fever alongwith exacerbation of cough. He was febrile, pulse rate was 96/min and B.P was 130/80 mm Hg. Surgery was delayed and patient was placed on antibiotics which included Inj. Cefuroxime 750 mg i/v 8 hourly, along with Salbutamol solution 2.5 mg 8 hourly in 5 cc of normal saline nebulization, tab Theophylline half BD, tab Clarithromycin 500 mg BD and Cap Omeprazole 200 mg HS were started. Meanwhile, patient was reviewed for possible surgical complication/intervention. The condition of patient however did not improve and the case was reviewed. His BP was 90/60 mmHg, pulse 88/min and temp 98F. There were scattered crepts and rhonchi bilaterally. Injection Ceftriaxone 1 g i/v BD and Clarithromycin infusion 500 mg i/v BD started while tab Clarithromycin and Inj. Cefuroxime were omitted. He was transferred to Military Hospital Rawalpindi where he was found to have fever, exacerbation of cough and decreased appetite. X-rays chest on 6th Feb 2002 showed patchy brochiectasis and consolidation. Serum urea was 18.2 mmol/I and random blood sugar 5.4 mmol/I. LFT`s were within normal limits. Arterial Blood Gases were suggestive of hypoxemia. Hydration therapy with i/v distilled water and Ringer`s locate 1000 ml each once daily started. the case was also revised for any obstruction of hernia. Patient was transfused with one pint of RCC and inj Amoxicillin 500 mg i/v TID added. His medical status continued fluctuating. On 8th Feb, 2002 yielded the growth of stenotrophomonas maltophilia, which was resistant to Ampicillin, Chloramphenicol, Tetracycline, Sulphamethoxazole Trimethoprim, Gentamicin, Amikacin, Ceftazidime, Cefoperazone, Ciprofloxacin, At 0135 hrs on 9th Feb 2002 patient went into cardio-respiratory arest. CPR was carried out but failed. Sputum or any other respiratory specimen for CS and post mortem examination were not carried out.

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