<i>Stenotrophomonas maltophilia</i>ventilator-associated pneumonia. A retrospective matched case-control study

Scholte, Johannes B. J.; Zhou, Tan Lai; Bergmans, Dennis C. J. J.; Rohde, Gernot; Winkens, Björn; Dessel, Helke A. van; Dormans, Tom; Linssen, Catharina F. M.; Roekaerts, P. M. H. J.; Savelkoul, Paul H. M.; Mook, Walther N. K. A. van

doi:10.1080/23744235.2016.1185534

Cited by 17 publications

(10 citation statements)

References 36 publications

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“…The present study echoes their findings, indicating that hematological abnormalities complicate the clinical course of SM respiratory infection and worsen the disease outcome. Although neutrophil counts may have been a decisive factor in infection control and hematopoiesis ability, it was also shown to be a significant risk factor in PH in previous studies ( 18 ). After multivariate analysis, we found that neutropenia was not an independent risk factor in PH or associated mortality, implying that neutropenia is, probably, a collateral finding along with underlying disease and thrombocytopenia.…”

Section: Discussionmentioning

confidence: 93%

Serial platelet level index improves prediction of pulmonary hemorrhage in patients with Stenotrophomonas maltophilia respiratory infections and thrombocytopenia

Cheng

et al. 2022

Front. Med.

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Patients with thrombocytopenia (platelet count <150 × 103/μL) often develop pulmonary hemorrhage (PH) after Stenotrophomonas maltophilia (SM) respiratory infection, resulting in a high respiratory failure rate and increased mortality. Developing an efficient method for early prediction of PH in these patients may improve survival. This study aimed to evaluate risk factors in PH and to develop an index measuring serial platelet deficit to predict PH in patients with SM respiratory infection. Data of patients with SM respiratory infection and thrombocytopenia treated in a tertiary university hospital during 2018–2020 were retrospectively retrieved from electronic medical records and analyzed. SM respiratory infection was defined as SM isolated from sputum, endotracheal suction, or bronchial alveolar lavage plus acute respiratory symptoms. Between PH and non-PH groups, clinical characteristics and laboratory parameters were collected and compared. The newly developed platelet dissimilarity index (d-index) was calculated by accumulating differences between the actual and the lowest normal level of the platelet count in each patient at different time points. Within 1,039 patients with positive SM culture, 437 cases matched the criteria and were analyzed. A total of 125 (28.6%) patients developed PH and 312 (71.4%) did not. The patients with PH had increased prothrombin time/international normalized ratio (PT/INR), lower platelet count, and higher platelet d-index. Multivariate analysis revealed that extreme thrombocytopenia (platelet count <50 × 103/μL) is a common independent risk factor in PH and mortality. The performance of platelet deficit and d-index varied between patients with different comorbidities. Performance of platelet deficit to predict PH is better in patients with hematology/oncology or liver disease (area under curve, 0.705–0.757), while d-index is better in patients with sepsis/treatment and various other groups (0.711–0.816). Prolonged and extreme thrombocytopenia is a determinant risk factor in PH in patients with SM respiratory infection. Given the complexity of causes of thrombocytopenia and associated comorbidities, different strategies should be applied when assessing the risk for PH.

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Section: Discussionmentioning

confidence: 93%

Serial platelet level index improves prediction of pulmonary hemorrhage in patients with Stenotrophomonas maltophilia respiratory infections and thrombocytopenia

Cheng

et al. 2022

Front. Med.

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“…Firstly, 1,156 papers were initially searched in the database through the search strategy, and then 43 papers were selected through title, abstract and keywords, etc. Finally, eight papers ( 9 – 16 ) were further screened by reading the full text, including five papers in English and three papers in Chinese ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Acquired Stenotrophomonas maltophilia Pneumonia in Intensive Care Unit: A Systematic Review and Meta-Analysis

2022

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Background and Aims:Stenotrophomonas maltophilia is increasingly found in critically ill patients, but it is considered a pathogen of limited pathogenicity and therefore it is not often targeted. We systematically evaluated risk factors for S. maltophilia pneumonia in ICU patients for better clinical management.Methods: Prospective and retrospective studies of S. maltophilia infection in the ICU from database establishment to August 8, 2021, were searched through PubMed, web of science, Cochrane Library Embase and CNKI. The literature was independently screened and extracted by two authors according to inclusion and exclusion criteria, evaluated for quality by the NOS scale, and meta-analyzed by stata 14.0 software.Results: A total of eight studies with a sample size of 2,320 cases were included. Meta-analysis showed that APACHE-II score > 20 (OR = 10.98, 95% CI: 5.67 ~ 21.26), COPD (OR = 3.97, 95% CI: 2.39 ~ 6.61), malignant tumor (OR = 2.15, 95% CI: 1.03 ~ 4.50), mechanical ventilation (OR = 8.75, 95% CI: 2.59 ~ 29.58), tracheotomy (OR = 6.12, 95% CI: 2.06 ~ 18.18), endotracheal intubation (OR = 4.25, 95% CI: 2.30 ~ 7.84), β- Lactamase inhibitors (OR = 9.98, 95% CI: 1.51 ~ 65.96), aminoglycosides (OR = 4.01, 95% CI: 2.06 ~ 7.80), carbapenems (OR = 2.82, 95% CI: 1.49 ~ 5.31), and quinolones (OR = 2.17, 95% CI: 1.21 ~ 3.89) were risk factors for ICU-acquired S. maltophilia pneumonia.Conclusion: Many risk factors are associated with S. maltophilia pneumonia in ICU patients. Clinical workers should pay more attention to assessing the risk of infection in ICU patients and enhance the prevention and management of high-risk groups, which will help reduce their risk of S. maltophilia infection.

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“…Regimes based on the use of CZA have been already demonstrated to be more effective than other available antibiotic agents for the treatment of infection caused by class A carbapenemase (KPC) producing K. pneumoniae [ 25 ] in critically ill mechanically ventilated patients [ 26 ]. However, few data are available concerning its efficacy in the treatment of DTT non-fermenter gram-negative (NFGN) bacteria such as Pseudomonas spp., Burkholderia cepacia , and Stenotrophomonas maltophilia which are frequently associated with VAP [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Ceftazidime/Avibactam in Ventilator-Associated Pneumonia Due to Difficult-to-Treat Non-Fermenter Gram-Negative Bacteria in COVID-19 Patients: A Case Series and Review of the Literature

et al. 2022

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Ventilator-associated pneumonia (VAP) in critically ill patients with COVID-19 represents a very huge global threat due to a higher incidence rate compared to non-COVID-19 patients and almost 50% of the 30-day mortality rate. Pseudomonas aeruginosa was the first pathogen involved but uncommon non-fermenter gram-negative organisms such as Burkholderia cepacea and Stenotrophomonas maltophilia have emerged as other potential etiological causes. Against carbapenem-resistant gram-negative microorganisms, Ceftazidime/avibactam (CZA) is considered a first-line option, even more so in case of a ceftolozane/tazobactam resistance or shortage. The aim of this report was to describe our experience with CZA in a case series of COVID-19 patients hospitalized in the ICU with VAP due to difficult-to-treat (DTT) P. aeruginosa, Burkholderia cepacea, and Stenotrophomonas maltophilia and to compare it with data published in the literature. A total of 23 patients were treated from February 2020 to March 2022: 19/23 (82%) VAPs were caused by Pseudomonas spp. (16/19 DTT), 2 by Burkholderia cepacea, and 6 by Stenotrophomonas maltophilia; 12/23 (52.1%) were polymicrobial. Septic shock was diagnosed in 65.2% of the patients and VAP occurred after a median of 29 days from ICU admission. CZA was prescribed as a combination regimen in 86% of the cases, with either fosfomycin or inhaled amikacin or cotrimoxazole. Microbiological eradication was achieved in 52.3% of the cases and the 30-day overall mortality rate was 14/23 (60.8%). Despite the high mortality of critically ill COVID-19 patients, CZA, especially in combination therapy, could represent a valid treatment option for VAP due to DTT non-fermenter gram-negative bacteria, including uncommon pathogens such as Burkholderia cepacea and Stenotrophomonas maltophilia.

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Stenotrophomonas maltophiliaventilator-associated pneumonia. A retrospective matched case-control study

Abstract: Stenotrophomonas maltophilia is a possible, yet infrequent cause of VAP. No outcome differences were found when compared to matched VAP caused by other Gram-negative bacilli.

Cited by 17 publications

References 36 publications

Serial platelet level index improves prediction of pulmonary hemorrhage in patients with Stenotrophomonas maltophilia respiratory infections and thrombocytopenia

Serial platelet level index improves prediction of pulmonary hemorrhage in patients with Stenotrophomonas maltophilia respiratory infections and thrombocytopenia

Risk Factors for Acquired Stenotrophomonas maltophilia Pneumonia in Intensive Care Unit: A Systematic Review and Meta-Analysis

Ceftazidime/Avibactam in Ventilator-Associated Pneumonia Due to Difficult-to-Treat Non-Fermenter Gram-Negative Bacteria in COVID-19 Patients: A Case Series and Review of the Literature

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