Clinical Importance of Stenotrophomonas maltophilia Nosocomial Pneumonia Due to its High Mortality in Hemodialysis Patients

Abstract

Patients undergoing hemodialysis are immunocompromised and can suffer from pneumonia with various pathogens in nosocomial conditions. We investigated the fundamental information on the characteristics of hemodialysis inpatients and nosocomial pneumonia. We surveyed 1803 hemodialysis patients admitted to our university hospital between 2001 and 2007. The mean patient age was 64.8 years and the average period of hospitalization was 28.1 days, which was considerably longer than the average stay in our hospital (14.2 days). Patients were admitted to many different departments and for various reasons. We isolated 391 microorganisms from the sputum of 120 pneumonia patients undergoing hemodialysis, including Candida albicans, methicillin-resistant Staphylococcus aureus, and Staphylococcus epidermidis, which were the leading three isolates. From these 120 patients, a total of 199 pathogens were identified as being responsible for the pneumonia. Multi-drug resistant Stenotrophomonas maltophilia was found to be susceptible to a new fluoroquinolone, but is resistant to older generation quinolones. Out of the 120 patients with pneumonia, 12 out of 18 patients infected with S. maltophilia died, indicating the highest fatality rate for this pathogen. In this survey, we found that hemodialysis patients were hospitalized for long periods, and for various reasons in many departments. They suffered from nosocomial pneumonia caused by multi-drug resistant pathogens, including S. maltophilia. For pneumonia due to S. maltophilia, new generation fluoroquinolones can be the treatment of choice, although S. maltophilia-related pneumonia should be treated very carefully because of its high fatality rate.

Serum Creatinine and Albumin Decline Predict the Contraction of Nosocomial Aspiration Pneumonia in Patients Undergoing Hemodialysis

“…Consistently, the pharmacotherapies frequently used in AP in HD patients were carbapenem and vancomycin. These data confirmed our previous report on the surveillance of 1803 HD patients admitted to our university hospital . Pneumonia by S. maltophilia exhibited high fatality in that report.…”

Clinical and microbiological evaluation of hemodialysis-associated pneumonia (HDAP): should HDAP be included in healthcare-associated pneumonia?

“…Another Japanese report [17] showed the microbiological spectrum of only HAP in hemodialysis patients. Because normal flora were not excluded, Candida albicans and S. epidermidis were the top two organisms.…”

Outbreak of nonfermentative Gram‐negative bacteria (Ralstonia pickettii and Stenotrophomonas maltophilia) in a hemodialysis center

“…Previous case reports have reported isolated cases of R. pickettii infection from different dialysis centers. 29 There were also reports of multiorganisms outbreaks in hemodialysis patients, where S. maltophilia was identified concurrently with other pathogens 36,37 In our case report, water from dialysis treatment plant has been infected by the two pathogens and was transmitted to the patients during the dialysis procedure. Vincenti et al also reported the co-existence of these two pathogens in water sources (tap water and water used for hemodialysis and bronchoscopy flushings) in a tertiary care hospital but there were no direct consequence of infection to patients.…”

“…There were also reports of multiorganisms infections that feature S. maltophilia causing septicemia and pneumonia, although it was difficult to ascertain which pathogen was directly responsible for clinical infection. 37 The same study reported that 12 out of 18 patients with co-existing S. maltophilia died from the infection. Table 2 showed a summary of case reports of hemodialysis patients directly affected by R. pickettii and S. maltophilia.…”

“…The article concluded that dialyser reuse and reprocessing equipment contributed to the risk of infection. There were also reports of multiorganisms infections that feature S. maltophilia causing septicemia and pneumonia, although it was difficult to ascertain which pathogen was directly responsible for clinical infection . The same study reported that 12 out of 18 patients with co‐existing S. maltophilia died from the infection.…”