Risk Factors and Clinical Characteristics of Stenotrophomonas Maltophilia Infections

Abstract Introduction: Stenotrophomonas maltophilia is an important nosocomial pathogen, particularly in immunocompromised patients, especially in patients with hematologic diseases. Methods: We reviewed the clinical characteristics and prognosis of patients with S. maltophilia bacteremia over a five-year period from January 2010 to December 2014. Species identification was performed using the automated Vitek 2 compact system (bioMe rieux). Results: The incidence of S. maltophilia bacteremia was 25.1 per 10 000 admissions in our study. Thirty-four patients (median age: 34 years; 64.7% males) with S. maltophilia bacteremia were analyzed. The S. maltophilia bacteremia related 30-day mortality was 44.1%. Risk factors associated with mortality in patients with S. maltophilia infection in the univariate and multivariate analysis were represented in Tables I and II. In the univariate analysis, risk factors included T>39.0¡æ, septic shock, respiratory failure and non-remission after treatment for primary hematological diseases (P <0.05). In the multivariate analysis, respiratory failure and non-remission status after treatment forhematological diseases were independent prognostic factors for mortality. In vitro susceptibility was higher to ciprofloxacin(82.4%), ceftazidime(70.6%), sulbactam and cefoperazone(58.8%), which was shown in Table III. Conclusion: Combination regimens with ciprofloxacin and ceftazidime, or sulbactam and cefoperazone could be alternative treatment. Novel antibiotics are required for treatment of S. maltophilia infection, as well as infection control practices of environmental reserves, rapid detection of pathogens, risk stratification strategy and appropriate treatment for primary hematologic malignancies, which might conjointly contribute to better survival outcome of S. maltophilia bacteremia. Univariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Table 1. Factor Mortality HR 95%CI P-value Withfactor Withoutfactor T>39.0¡æ 75% 16.7% 2.490 1.318-4.704 0.005 Septic shock 90.0% 25.0% 2.544 1.473-4.393 0.001 Respiratory failure 100% 20.8% 4.672 2.366-9.225 0.000 Treatment outcome for hematological diseases Remission 10.0% 85.7% 0.247 0.116-0.526 0.000 HR, hazard ratio; CI, confidence interval; HSCT, Hematopoietic stem cell transplantation Table 2. Multivariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Factor HR 95%CI P-value Respiratory failure 2.688 1.297-5.569 0.008 Remission after treatment for hematological diseases 0.367 0.153-0.879 0.025 HR, hazard ratio; CI, confidence interval Table 3. Susceptibility pattern of the 34 patients with Stenotrophomonas maltophilia bacteremia Antimicrobial agents S (%) I (%) Ceftazidime 24(70.6%) 1(2.9%) Cefoperazone 19(44.1%) 6(17.6%) Sulbactam and Cefoperazone 20(58.8%) 5(14.7%) Piperacillin 7(20.6%) 6(17.6%) Piperacillin-Tazobactam 11(32.3%) 7(20.6%) Amikacin 6(17.6%) 0(0%) Ciprofloxacin 28(82.4%) 1(2.9%) S, susceptible; I, intermediately susceptible. Disclosures No relevant conflicts of interest to declare.

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Fatal hemorrhagic pneumonia in patients with hematologic diseases and Stenotrophomonas maltophilia bacteremia: a retrospective study

BMC Infectious Diseases ◽

10.1186/s12879-021-06420-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lixia Zhu ◽

Lulu Wang ◽

Yuping Zhang ◽

Rongrong Chen ◽

Xueying Li ◽

...

Keyword(s):

Risk Factors ◽

Stenotrophomonas Maltophilia ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Hematologic Diseases ◽

Hemorrhagic Pneumonia ◽

Independent Risk Factors ◽

High Level ◽

Clinical Records ◽

Overall Mortality

Abstract Background Fatal hemorrhagic pneumonia is one of the most severe manifestations of Stenotrophomonas maltophilia (SM) infections. Here, we aimed to investigate the clinical characteristics of SM bacteremia and to identify the risk factors of hemorrhagic pneumonia caused by SM in patients with hematologic diseases. Methods The clinical records of 55 patients diagnosed with hematologic diseases and SM bacteremia were retrospectively reviewed. We compared patients’ clinical characteristics and outcomes between the hemorrhagic pneumonia group and non-hemorrhagic pneumonia group. Results Twenty-seven (49.1%) patients developed hemorrhagic pneumonia. The overall mortality rate of SM bacteremia was 67.3%. Hemorrhagic pneumonia (adjusted HR 2.316, 95% CI 1.140–4.705; P = 0.020) was an independent risk factor of 30-day mortality in hematological patients with SM bacteremia. Compared with the non-hemorrhagic pneumonia group, patients in the hemorrhagic pneumonia group were older and showed clinical manifestations as higher proportions of isolated SM in sputum culture, neutropenia and elevated procalcitonin (PCT). Multivariate analysis showed that neutropenia, high levels of PCT, prior tigecycline therapy within 1 month were independent risk factors associated with hemorrhagic pneumonia. Conclusions Neutropenia, high level of PCT and prior tigecycline therapy within 1 month were significant independent predictors of hemorrhagic pneumonia in hematologic patients with SM bacteremia. Due to no effective antibiotics to prevent hemorrhagic pneumonia, prophylaxis of SM infection and its progression to hemorrhagic pneumonia is particularly important.

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Fatal hemorrhagic pneumonia in patients with hematologic diseases and Stenotrophomonas maltophilia bacteremia: a retrospective study

10.21203/rs.3.rs-366323/v1 ◽

2021 ◽

Author(s):

Lixia ZHU ◽

Lulu Wang ◽

Yuping Zhang ◽

Rongrong Chen ◽

Xueying Li ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Stenotrophomonas Maltophilia ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Hematologic Diseases ◽

Hemorrhagic Pneumonia ◽

Life Threatening ◽

High Level ◽

Clinical Records

Abstract Background Fatal hemorrhagic pneumonia is one of the most severe manifestations of Stenotrophomonas maltophilia (SM) infections. Here, we aimed to investigate the clinical characteristics of SM bacteremia and to identify the risk factors of hemorrhagic pneumonia caused by SM in patients with hematologic diseases. Methods The clinical records of 55 patients diagnosed with hematologic diseases and SM bacteremia were retrospectively reviewed. We compared patients’ clinical characteristics and outcomes between the hemorrhagic pneumonia group and non-hemorrhagic pneumonia group. Results Twenty-seven (49.1%) patients developed hemorrhagic pneumonia. The overall mortality rate of SM bacteremia was 67.3%. The 30-day mortality rate was significantly higher in patients with hemorrhagic pneumonia than those without hemorrhagic pneumonia (85.2% and 50.0%, respectively, P = 0.003). Compared with the non-hemorrhagic pneumonia group, patients in the hemorrhagic pneumonia group were older and showed clinical manifestations as higher proportions of isolated SM in sputum culture, neutropenia and elevated procalcitonin. Multivariate analysis showed that neutropenia, high levels of procalcitonin, prior tigecycline therapy within 1 month were independent risk factors associated with hemorrhagic pneumonia. Conclusions Hematologic patients with SM bacteremia who have neutropenia, high level of procalcitonin and prior tigecycline therapy within 1 month should be early treated with combined effective antibiotics and best supportive interventions to avoid life-threatening hemorrhagic pneumonia.

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Clinical characteristics and prognostic factors of patients with Stenotrophomonas maltophilia infections

Journal of Laboratory Physicians ◽

10.4103/0974-2727.199639 ◽

2017 ◽

Vol 9 (02) ◽

pp. 132-135 ◽

Cited By ~ 3

Author(s):

Priyam Batra ◽

Purva Mathur ◽

Mahesh C. Misra

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Stenotrophomonas Maltophilia ◽

Clinical Characteristics ◽

Resistance Pattern ◽

Pathogenic Potential ◽

Factors Associated ◽

Venous Catheterization ◽

Potential Pathogen ◽

Independent Risk Factors

Abstract INTRODUCTION: Stenotrophomonas maltophilia earlier had limited pathogenic potential, but now with growing degree of immunosuppression in general population, it is being recognized as an important nosocomial pathogen. METHODOLOGY: A retrospective 7 years study was carried out to determine the clinical characteristics of all patients with Stenotrophomonas infections, antibiotic resistance pattern, and risk factors associated with hospital mortality. All patients with Stenotrophomonas culture positivity were identified and their medical records were reviewed. Risk factor associated with hospital mortality was analyzed. RESULTS: A total of 123 samples obtained from 88 patients were culture positive. Most patients presented with bacteremia (45, 51%) followed by pneumonia (37, 42%) and skin and soft tissue infections (6, 7%). About 23 of 88 Stenotrophomonas infected patients had co-infection. Percentage resistance to cotrimoxazole; 8 (5.4%) was lower than that for levofloxacin; 18 (12%). Twenty-eight patients died during hospital stay. Intensive Care Unit admission (P = 0.0002), mechanical ventilation (P = 0.0004), central venous catheterization (P = 0.0227), urethral catheterization (P = 0.0484), and previous antibiotic intake (P = 0.0026) were independent risk factors associated with mortality. CONCLUSION: Our findings suggest that Stenotrophomonas can cause various infections irrespective of patient’s immune status and irrespective of potential source. Thus, Stenotrophomonas should be thought of as potential pathogen and its isolation should be looked with clinical suspicion.

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Clinical characteristics and risk factors of infections caused by Stenotrophomonas maltophilia in a hospital in northwest China

The Journal of Infection in Developing Countries ◽

10.3855/jidc.4236 ◽

2014 ◽

Vol 8 (08) ◽

pp. 1000-1005 ◽

Cited By ~ 7

Author(s):

Meng Xun ◽

Yi Zhang ◽

Bo-Ling Li ◽

Min Wu ◽

Yuan Zong ◽

...

Keyword(s):

Risk Factors ◽

Stenotrophomonas Maltophilia ◽

Clinical Characteristics ◽

Positive Impact ◽

Venous Catheter ◽

Northwest China ◽

Antimicrobial Treatment ◽

Dilution Method ◽

Agar Dilution Method

Introduction: Stenotrophomonas maltophilia infections have recently increased in importance in China, particularly in intensive care units (ICUs). The aim of this study was to investigate the clinical characteristics and risk factors of S. maltophilia infection in ICU of a hospital in northwest China. Methodology: The characteristics and outcomes of patients with any type of S. maltophilia infection at Shaanxi Provincial People’s Hospital, Shaanxi, China, over a two-year period (from July 2011 to June 2013) were studied. S. maltophilia antimicrobial susceptibility was tested with the agar dilution method. The risk factors for all-cause in-hospital mortality were assessed with multivariate logistic regression. Results: Forty patients (median age, 72 years; 77.5% males) with S. maltophilia infection were identified. The main type of infection was lower respiratory tract infection (97.5%); one patient had a bloodstream infection. A total of 97.5% patients were infected with two or more organisms at the same time. The main characteristics of the patients were prolonged use of mechanical ventilation, urethral catheter, and central venous catheter before the infections occurred. The case number of infection was not different in the four seasons. High in vitro sensitivity was observed to minocycline (91.2%), levofloxacin (85.3%), and trimethoprim-sulfamethoxazole (79.4%). Most patients received therapy with a combination of agents. The crude mortality was 50%. By multivariate analysis, low albumin content and hypotension were the independent prognostic factors for mortality. Conclusions: Appropriate antimicrobial treatment had no positive impact on mortality. The impacts of albumin supplements and increasing blood pressure on mortality require further clinical studies.

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