Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia

Abstract

Background Ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia is poorly described in the literature. However, it has been shown to be associated with increased morbidity and mortality. Probabilistic antibiotic therapy against S. maltophilia is often ineffective as this pathogen is resistant to many antibiotics. There is no consensus at present on the best therapeutic strategy to adopt (class of antibiotics, antibiotic combination, dosage, treatment duration). The aim of this study was to evaluate the effect of antibiotic therapy strategy on the prognosis of patients with VAP caused by S. maltophilia. Results This retrospective study evaluated all consecutive patients who developed VAP caused by S. maltophilia between 2010 and 2018 while hospitalized in the intensive care unit (ICU) of a French university hospital in Reunion Island, in the Indian Ocean region. A total of 130 patients with a median Simplified Acute Physiology Score II of 58 [43–73] had VAP caused by S. maltophilia after a median duration of mechanical ventilation of 12 [5–18] days. Ventilator-associated pneumonia was polymicrobial in 44.6% of cases, and ICU mortality was 50.0%. After multivariate Cox regression analysis, the factors associated with increased ICU mortality were older age (hazard ratio (HR): 1.03; 95% CI 1.01–1.04, p = 0.001) and high Sequential Organ Failure Assessment score on the day of VAP onset (HR: 1.08; 95% CI 1.03–1.14, p = 0.002). Appropriate antibiotic therapy, and in particular trimethoprim–sulfamethoxazole, was associated with decreased ICU mortality (HR: 0.42; 95% CI 0.24–0.74, p = 0.003) and decreased hospital mortality (HR: 0.47; 95% CI 0.28–0.79, p = 0.04). Time to start of appropriate antibiotic therapy, combination therapy, and duration of appropriate antibiotic therapy had no effect on ICU mortality (p > 0.5). Conclusion In our study, appropriate antibiotic therapy, and in particular trimethoprim–sulfamethoxazole, was associated with decreased ICU and hospital mortality in patients with VAP caused by S. maltophilia.

Clinical Features and Outcomes of VAP Due to Multidrug-Resistant Klebsiella spp.: A Retrospective Study Comparing Monobacterial and Polybacterial Episodes

“…Furthermore, the Klebsiella species accounted only for 3.1% of all pathogens, and caused monobacterial cases only. Yet, there are studies of pneumonia that, similar to our findings, have revealed higher mortality in polybacterial cases [21,28,33].…”

Influence of antibiotic therapy on clinical outcomes of patients with Stenotrophomonas maltophilia blood stream infection in the intensive care unit

“…The relatively smaller sample size in that study (only 35 S. maltophilia BSI cases included), with a low statistical power, may have accounted for the insigni cant effect of antibiotic therapy on the outcomes [32]. Among the studies focused on pneumonia caused by S. maltophilia in ICU, some studies revealed that antibiotic therapy may effect the clinical outcomes whereas others showed no such association [20,21,34,35]. The different ICU settings, respiratory copathogen diversity, and a heterogeneous population may explain the inconsistent effects of antibiotic therapy on the clinical outcomes in these studies.…”

Assessment of the relative benefits of monotherapy and combination therapy approaches to the treatment of hospital-acquired Stenotrophomonas maltophilia pneumonia: a multicenter, observational, real-world study

“…Higher APACHE II scores were also found to be related to an elevated mortality rate in this study cohort, consistent with prior research results [ 20 , 21 ]. For example, Kanchanasuwan et al [ 21 ] and Puech et al [ 22 ] determined that appropriate empirical antimicrobial treatment was related to a significant reduction in 30-day mortality, with higher baseline APACHE II scores serving as an independent predictor of mortality risk. A longer interval between HAP onset and definitive treatment was also associated with a higher risk of death in the present study, highlighting the importance of promptly administering appropriate antimicrobial drugs to most effectively treat S. maltophilia -HAP.…”