<p><em>Stenotrophomonas maltophilia</em> Infections: Clinical Characteristics and Factors Associated with Mortality of Hospitalized Patients</p>

Abstract

Purpose: To study the clinical characteristics and factors associated with mortality of patients who had Stenotrophomonas maltophilia infections. Patients and Methods: We conducted a retrospective study to determine the clinical characteristics and factors associated with mortality for S. maltophilia infections among hospitalized adult patients at Siriraj Hospital. The clinical and microbiological data were collected from medical records December 2013-December 2016. Results: Of 1221 subjects whose clinical samples grew S. maltophilia, 213 were randomly selected for chart review. One hundred patients with a true infection were analyzed. Their median age was 66 years; 47 were males; 46 were critically ill with a median APACHE II score of 18 (2-32); and 91 received antibiotic treatment, mainly with carbapenems (56%), before being diagnosed with a S. maltophilia infection. Pulmonary (53%) and bloodstream infections (25%) were the most common infections. The median length of hospitalization was 19 days before infection onset. The in-hospital mortality rate was 54%. The following factors were associated with mortality: a pre-existing respiratory infection (OR 6.28, 1.33-29.78; p.021); critical illness (OR 3.33, 1.45-7.62; p.005); multi-organ dysfunction (OR 2.44, 1.05-5.70; p.039); being on mechanical ventilation (OR 4.44, 1.90-10.39; p.001); concurrent immunosuppressive therapy (OR 2.67, 1.10-6.47; p.029); intravascular (OR 4.43, 1.79-10.92; p.001) and urinary catheterization (OR 4.83, 1.87-12.47; p.001); and serum albumin <3 g/dL (OR 4.13, 1.05-16.33; p.043). A multivariate analysis identified two independent factors associated with mortality: being on mechanical ventilation (OR 4.43, 1.86-10.59; p 0.001) and receiving concurrent immunosuppressive therapy (OR 2.26, 1.04-6.82; p 0.042). Conclusion: S. maltophilia can cause nosocomial infections with high mortality, particularly in patients with a prolonged hospitalization. Concurrent immunosuppressive therapy and being on mechanical ventilation are the independent factors associated with a fatal outcome.

Phenotypic and Molecular Characteristics of the MDR Efflux Pump Gene-Carrying Stenotrophomonas maltophilia Strains Isolated in Warsaw, Poland

“…According to Chang et al [ 27 ], the prevalence of S. maltophilia infections in the global population increased from 1.3% to 1.7% between 2007 and 2012. The isolation of these bacteria from blood samples as an etiological factor of bacteremia is of particular concern [ 28 , 29 ]. In this study we characterized 94 S. maltophilia isolates by phenotypic and genotypic methods, including 79 isolates from patients hospitalized in one tertiary Warsaw hospital, of which 27 were isolated from blood.…”

Infeksi dan Pola Kepekaan Stenotrophomonas maltophilia di ICU RS X

“…18 Penelitian lain mengenai mortalitas pasien terinfeksi S. maltophilia di Thailand, didapatkan angka mortalitas mencapai 54%, dengan 46% dari seluruh pasien yang diteliti sudah dalam kondisi sakit kritis saat masuk ke rumah sakit. 19 Hal ini serupa dengan penelitian ini di mana pada kasus kematian yang ditemukan, terbukti terdapat infeksi SARS-CoV2 yang dibuktikan dengan hasil qRT-PCR. Pada penelitian ini tidak melihat hasil kultur darah yang diambil bersamaan dengan sampel dari paru untuk membuktikan bakteremia oleh karena S. maltophilia.…”

“…(2020), Kepekaan cotrimoxazole dan levofloxacin tidak berbeda jauh yaitu berturut-turut 94 dan 91%. 19 Berbeda dengan hasil kepekaan cotrimoxazole pada studi S.maltophilia di Mataram yang hanya mencapai 8,33%, sedangkan untuk levofloxacin tidak dilakukan uji melainkan menguji terhadap fluoroquinolone lain yaitu ciprofloxacin dengan sensitivitas 58,3%. 16 Berdasarkan data ini, sensitivitas levofloxacin tidak dapat dipastikan secara mutlak namun diperkirakan tidak akan jauh dari 58,3%.…”

Isolation of Stenotrophomonas maltophilia from Clinical Samples in Some Hospitals in Shiraz, Iran

“…It has been isolated from hospital sources such as medical equipment, hospital water supply, sinks, disinfectant solutions, dialysis devices, ventilators, central venous catheters, thermometers, blood gas analysers, distilled water dispensers and intra-aortic balloon pumps are among the main hospital devices and equipment from which it can be isolated. Although S. maltophilia has relatively low pathogenic power, it can cause a broad spectrum of dangerous infections such as pneumonia, bacteremia, endocarditis, meningitis, wound and soft tissue infections, osteomyelitis, keratitis and urinary tract infections, especially in patients with immunodeficiency [3].…”

“…Thus, high incidence of infections due to S. maltophilia can be expected in immunocompromised patients [4]. Several factors such as intrinsic resistance to antimicrobial agents, production of proteolytic enzymes and other pathogenic extracellular enzymes such as DNase, RNase, elastase, lipase, hyaluronidase, mucinase and hemolysin [3]. Resistance in S. maltophilia to various antibiotics can lead to numerous problems in controlling hospital-acquired infections and threaten public health.…”