Managing Multidrug-Resistant Stenotrophomonas Maltophilia Sepsis in a Child with Cerebral Palsy and Global Developmental Delay: A Complex Rare Case from a Resource-Limited Setting

Stenotrophomonas maltophilia is a hospital-acquired, multidrug-resistant pathogen that poses significant therapeutic challenges, particularly in children with complex comorbidities. We report the case of a 5-year-old girl with cerebral palsy, global developmental delay, and epilepsy who developed S. maltophilia sepsis. She initially presented with fever and vomiting, followed by rapid clinical deterioration with pneumonia, septic shock, acute kidney injury, and new-onset seizures. Her course was further complicated by an underlying horseshoe kidney and suspected rectovaginal fistula. Despite empirical broad-spectrum antibiotic therapy, clinical improvement was not observed until blood culture identified S. maltophilia, resistant to most antibiotics but susceptible to trimethoprim-sulfamethoxazole, levofloxacin, and ciprofloxacin. Targeted antimicrobial therapy resulted in gradual recovery. Additional management included central line removal, re-initiation of antifungal therapy for persistent candiduria, and optimization of antiepileptic treatment. This case highlights the importance of early microbiological diagnosis, individualized pathogen-directed therapy, and vigilant monitoring when managing multidrug-resistant infections in resource-limited pediatric settings.