Stenotrophomonas maltophilia Infection Associated with COVID-19: A Case Series and Literature Review

Case series Patients: Female, 52-year-old • Male, 80-year-old • Male, 48-year-old • Male, 80-year-old Final Diagnosis: COVID pneumonia Symptoms: Cough Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Background: Case Reports: Conclusions: Rare disease We aimed to identify the risk factors for Stenotrophomonas maltophilia infection in patients with COVID-19. Case 1. A 52-year-old COVID-19-positive woman with systemic lupus erythematosus was administered remde-sivir (RDV) and methylprednisolone (mPSL) 1000 mg/day for 3 days, and subsequently administered baricitinib and ceftriaxone. Following respiratory deterioration, she was transferred to the Intensive Care Unit (ICU) and the antibiotics were switched to meropenem (MEPM). Blood and sputum cultures were positive for S. malto-philia. Administration of trimethoprim-sulfamethoxazole (TMP-SMX) showed clinical improvement. Case 2. An 80-year-old COVID-19-positive man was treated with RDV, dexamethasone, and baricitinib. Owing to severe hypoxia, he was transferred to the ICU and MEPM was administered. Sputum culture was positive for S. maltophilia. TMP-SMX administration temporarily improved his symptoms; however, he died from COVID-19-associated invasive aspergillosis. Case 3. A 48-year-old COVID-19-positive man who was mechanically intubated was transferred to our hospital and treated with RDV, mPSL, and piperacillin/tazobactam. Sputum culture revealed S. maltophilia; treatment with TMP-SMX improved his respiratory status. Case 4. An 80-year-old COVID-19-positive man was treated with RDV and dexamethasone. Owing to severe hy-poxemia, he was transferred to the ICU and the antibiotics were switched to MEPM. Sputum culture revealed S. maltophilia. Administration of TMX-SMX improved his respiratory status. Isolation of S. maltophilia in respiratory specimens of patients with COVID-19 should prompt clinicians to ad-minister treatment for S. maltophilia-associated pneumonia in ICU-admitted patients who have been intubat-ed, have been administered broad-spectrum antibiotics, or have immunocompromised status.