Multicenter Epidemiology of Stenotrophomonas maltophilia Bloodstream Infections in Indian ICUs: Building Digital Surveillance Network

Parul Singh¹M Nizam Ahmed¹ASHISH KUMAR SRIVASTAVA¹Arpan Kumar Thakur¹Rasna Parveen¹Mamta Puraswani¹Subodh Kumar¹Sushma Sagar¹Kapil Dev Soni¹Richa Aggarwal¹Ashish Bindra¹Keshav Goyal¹Kamran Farooque¹Arunaloke Chakrabarti²Camilla Rodrigues²Balaji Veeraraghavan³Pallab Ray²Manisha Biswal²Neelam Taneja²Archana Angrup²Chand Wattal⁴Vimala Venkatesh⁵Nandini Sethuraman⁶Sanjay Bhattacharya⁷VIBHOR TAK⁸Bijayini Behera⁹Vinaykumar Hallur⁹Raja Ray¹⁰Shivaprakash M Rudramurthy²Inderpaul Sehgal²Sanjeev K Singh¹¹Sharmila Sen Gupta¹¹Chiranjay Mukhopadhyay¹²Joy Sarojini Michael³Dr Bashir Ahmad Fomda¹³Tadepalli Karuna¹⁴Vijayshri Deotale¹⁵Amber Prasad¹⁶Dr.Kanne Padmaja¹⁷Vijeta Bajpai¹⁸Reema Nath¹⁹Renu Gur²⁰Sheela Devi Chandrakesan²¹Shalini Malhotra²²Rajni Gaind²³Ranjana Devi Khuraijam²⁴Rajni Sharma²⁵Summaiya Mullan²⁶John Antony Jude Prakash³Hema Paul³Priscilla Rupali³Sheetal Verma⁵Sangita Rajdev²⁶Neeraj Goel⁴Juliah Cheliah²⁷Satyam Mukherjee⁷Aparna Sonowal¹⁹Veena Kumari²⁸Prachi Verma²⁹Vandana K E¹²Manisha Subrao Mane³⁰Tapan Majumder³¹Kamini Walia³²Purva Mathur^1*

• ¹All India Institute of Medical Sciences Jai Prakash Narayan Apex Trauma Center, New Delhi, India
• ²Post Graduate Institute of Medical Education and Research, Chandigarh, India
• ³Christian Medical College Vellore, Vellore, India
• ⁴Sir Ganga Ram Hospital, New Delhi, India
• ⁵King George's Medical University, Lucknow, India
• ⁶Apollo Hospitals Chennai Greams Road, Chennai, India
• ⁷Tata Medical Center, Kolkata, India
• ⁸All India Institute of Medical Sciences Jodhpur, Jodhpur, India
• ⁹All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
• ¹⁰Institute of Postgraduate Medical Education and Research, Kolkata, India
• ¹¹Amrita Institute of Medical Sciences, Kochi, India
• ¹²Kasturba Medical College Manipal, Manipal, India
• ¹³Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
• ¹⁴All India Institute of Medical Sciences Bhopal, Bhopal, India
• ¹⁵Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
• ¹⁶All India Institute of Medical Sciences Rishikesh, Rishikesh, India
• ¹⁷Nizam's Institute of Medical Sciences, Hyderabad, India
• ¹⁸Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, India
• ¹⁹Assam Medical College, Dibrugarh, India
• ²⁰Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India
• ²¹Pondicherry Institute of Medical Sciences, Puducherry, India
• ²²Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital, New Delhi, India
• ²³Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
• ²⁴Regional Institute of Medical Sciences, Imphal, India
• ²⁵Sawai Man Singh Medical College and Hospital, Jaipur, India
• ²⁶Government Medical College Surat, Surat, India
• ²⁷P D Hinduja Hospital and Medical Research Center, Mumbai, India
• ²⁸National Institute of Mental Health and Neurosciences, Bengaluru, India
• ²⁹Mahatma Gandhi Medical College and Hospital, Jaipur, India
• ³⁰ESIC Medical College and Hospital, Hyderabad, India
• ³¹Agartala Government Medical College, Agartala, India
• ³²Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Delhi, India

Background: To investigate the geospatial epidemiology, clinical features, treatment patterns, and antimicrobial resistance (AMR) trends of Stenotrophomonas maltophilia bloodstream infections (BSIs) in Indian intensive care units (ICUs) participating in a standardized healthcare-associated infection (HAI) surveillance program from 2017 to 2024. Methods: This retrospective, multicentric study analyzed surveillance data from 54 ICUs across India. Standardized HAI definitions and protocols were applied to characterize infection types, clinical outcomes, and antimicrobial susceptibility. Results: A total of 271 S. maltophilia isolates were identified, with the highest burden in 2023–24 (n=76, 28.0%). Central line-associated BSIs (CLABSIs) predominated (64.9%), though their proportion decreased over time, with non-CLABSIs rising from 7.4% (2017–18) to 42.1% (2023–24). Mortality was highest in secondary BSIs (60%), followed by CLABSIs (50.3%) and non-CLABSIs (36.4%). The median ICU stay for CLABSI patients was 21 days. No significant associations were observed between infection type and time to infection or length of stay. High resistance was observed to tobramycin (92%), amikacin (80%), and piperacillin-tazobactam (70%), while trimethoprim-sulfamethoxazole (64.7–94.7%), levofloxacin (93%), and minocycline (94.1%) retained activity. Conclusion: S. maltophilia represents a significant ICU pathogen in India, underscoring the urgent need for genomic surveillance and resistance-guided therapeutic strategies.