Clinical Characteristics of <i>Stenotrophomonas maltophilia</i> Bacteremia: A Regional Report and a Review of a Japanese Case Series

Abstract

Objective Stenotrophomonas maltophilia is an emerging nosocomial pathogen that causes fatal infections in critically ill or immunocompromised patients. S. maltophilia bacteremia (SMB) is a rare condition, and its clinical characteristics in Japanese settings are not well known. Methods The medical charts of patients with SMB were retrospectively reviewed at two medical facilities (Okayama University Hospital and Tsuyama Chuo Hospital) for seven years. The data were analyzed along with those previously reported from other Japanese facilities. Result A total of 181 patients (110 men and 71 women) were evaluated. The major underlying diseases included hematologic malignancy (36.5%), solid organ malignancy (25.4%), and neutropenia (31.5%). The recent use of carbapenem was seen in 56.9% of the cases in total, and more than one-third of the patients in our hospitals were treated with carbapenem at the onset of SMB. Of 28 (63.6%) of 44 cases treated for S. maltophilia, those who did not survive were more likely to have been treated with broad-spectrum antibiotics. A multivariate analysis revealed that a higher updated Charlson Comorbidity Index [odds ratio (95% confidence interval), 1.75 (1.11-2.75); p=0.015] and intubation [odds ratio (95% confidence interval), 12.6 (1.62-97.9); p=0.016] were associated with mortality in our cases. Pathogens were often resistant to ceftazidime but susceptible to minocycline, trimethoprim/sulfamethoxazole, and fluoroquinolones. The overall mortality rates within 30 and 90 days were 37.5% and 62.5%, respectively. Conclusion The clinical characteristics of SMB in Japanese cases were similar to those reported from other countries. Clinicians should be aware that breakthrough infection by S. maltophilia may occur during administration of carbapenem.

Risk factors for mortality in patients with Stenotrophomonas maltophilia bacteremia and clinical impact of quinolone–resistant strains

“…Overall, the periods of empirical antibiotic use were short and there were no patients using TMP / SMX empirically, so whether the empirical use of quinolone actually had a significant impact needs to be analyzed further. Also, SM infections may not be an independent contributor to mortality increase, therefore inappropriate therapy should not have major effects on the outcome of patients [29]. The rate of polymicrobial infections in SM bacteremia was high in the previous literature [23] and in this study as well (42.8%).…”

Epidemiological Trends and Resistance Associated with Stenotrophomonas maltophilia Bacteremia: A 10-Year Retrospective Cohort Study in a Tertiary-Care Hospital in Hungary

“…In the study of Ebara et al, the retrospective epidemiological characterization of two medical hospitals were performed: the corresponding susceptibility rates of these isolates were 87.5% for SMX/TMP and 75.5% for levofloxacin [46]. In a retrospective, single-center study in Japan, spanning eight years, Hotta el al.…”

Ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii in view of the microbial properties of the ESKAPE group in neighbouring countries – Poland and Ukraine

“…Data from the literature suggests that, in addition to ESKAPE pathogens, the species Stenotrophomonas maltophilia should be included as a microorganism that causes more and more frequent infections in healthcare settings [1,20,21,22].…”