Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study

Abstract

BackgroundThere is little descriptive data on Stenotrophomonas maltophilia hospital-acquired pneumonia (HAP) in critically ill patients. The optimal modalities of antimicrobial therapy remain to be determined. Our objective was to describe the epidemiology and prognostic factors associated with S. maltophilia pneumonia, focusing on antimicrobial therapy.MethodsThis nationwide retrospective study included all patients admitted to 25 French mixed intensive care units between 2012 and 2017 with hospital-acquired S. maltophilia HAP during intensive care unit stay. Primary endpoint was time to in-hospital death. Secondary endpoints included microbiologic effectiveness and antimicrobial therapeutic modalities such as delay to appropriate antimicrobial treatment, mono versus combination therapy, and duration of antimicrobial therapy.ResultsOf the 282 patients included, 84% were intubated at S. maltophilia HAP diagnosis for duration of 11 [5–18] days. The Simplified Acute Physiology Score II was 47 [36–63], and the in-hospital mortality was 49.7%. Underlying chronic pulmonary comorbidities were present in 14.1% of cases. Empirical antimicrobial therapy was considered effective on S. maltophilia according to susceptibility patterns in only 30% of cases. Delay to appropriate antimicrobial treatment had, however, no significant impact on the primary endpoint. Survival analysis did not show any benefit from combination antimicrobial therapy (HR = 1.27, 95%CI [0.88; 1.83], p = 0.20) or prolonged antimicrobial therapy for more than 7 days (HR = 1.06, 95%CI [0.6; 1.86], p = 0.84). No differences were noted in in-hospital death irrespective of an appropriate and timely empiric antimicrobial therapy between mono- versus polymicrobial S. maltophilia HAP (p = 0.273). The duration of ventilation prior to S. maltophilia HAP diagnosis and ICU length of stay were shorter in patients with monomicrobial S. maltophilia HAP (p = 0.031 and p = 0.034 respectively).ConclusionsS. maltophilia HAP occurred in severe, long-stay intensive care patients who mainly required prolonged invasive ventilation. Empirical antimicrobial therapy was barely effective while antimicrobial treatment modalities had no significant impact on hospital survival.Trial registrationclinicaltrials.gov, NCT03506191

Discrimination of biofilm-producing Stenotrophomonas maltophilia clinical strains by matrix-assisted laser desorption ionization–time of flight

“…ICU-associated S. maltophilia infections seem to behave differently than those associated to the community [12]. S. maltophilia hospital-acquired pneumonia occurs in severe, long-stay intensive care patients with prolonged invasive ventilation, and in-hospital mortality can be as high as 49.7% [26]. ICU-obtained S. maltophilia isolates showed low clonality, 12 different sequence types and two isolates with the same allelic profile, corresponding to ST186.…”

Treatment refractoryStenotrophomonas maltophiliabacteraemia and pneumonia in a COVID-19-positive patient

“…1 The reported incidence of S. maltophilia infection ranges from 7.1 to 37.7 cases per 10 000 hospital discharges. [2][3][4][5] S. maltophilia is most frequently hospital-acquired, with pneumonia being the most common manifestation and bacteraemia being second most common. 6 Pulmonary infection is often preceded by respiratory tract colonisation, with mechanical ventilation being an important risk factor for both colonisation and infection.…”

“…7 There is high mortality associated with S. maltophilia infection, with a recent retrospective review of 282 patients with S. maltopohilia hospitalacquired pneumonia reporting a mortality rate of nearly 50%. 5 The COVID-19 pandemic, which has caused an increase in prolonged intensive care unit (ICU) stays for mechanical ventilation, has likely increased the incidence of opportunistic infections such as S. maltophilia infection. To our knowledge, there are only 12 reported cases in the literature documenting concomitant S. maltophilia and COVID-19 infection, of which all cases were of S. maltophilia pneumonia.…”

“… 7 There is high mortality associated with S. maltophilia infection, with a recent retrospective review of 282 patients with S. maltopohilia hospital-acquired pneumonia reporting a mortality rate of nearly 50%. 5 …”

Fatal hemorrhagic pneumonia in patients with hematologic diseases and Stenotrophomonas maltophilia bacteremia: a retrospective study

“…Stenotrophomonas maltophilia (SM) is a non-fermentative gram-negative bacterium without highly virulent widely found in nature, and rarely causes infection in the normal immune population [1]. However, SM has been becoming a common cause of opportunistic infections in immunocompromised patients, especially in patients diagnosed with hematologic diseases, and can cause serious infections, such as bacteremia or hemorrhagic pneumonia [2][3][4][5][6].…”