Risk Factors for Late‐Onset Nosocomial Pneumonia Caused byStenotrophomonas maltophiliain Critically Ill Trauma Patients

Abstract

Patients with nosocomial pneumonia caused by Stenotrophomonas maltophilia often receive inadequate empiric antibiotic therapy, potentially increasing mortality. Knowledge of the risk factors associated with S. maltophilia pneumonia may better guide the selection of empiric antibiotic therapy. Potential risk factors for S. maltophilia pneumonia were retrospectively analyzed for critically ill trauma patients with late-onset gram-negative pneumonia. The effects of S. maltophilia infection and inadequate empiric antibiotic therapy on patient outcomes were also assessed. By multivariate analysis, S. maltophilia pneumonia was found to be associated with cefepime exposure and tracheostomy in patients with a single pneumonia episode and with higher Injury Severity Score and pulmonary contusion in patients with multiple pneumonia episodes. S. maltophilia pneumonia was associated with increased patient morbidity; only inadequate empiric antibiotic therapy was associated with a higher mortality rate. In critically ill trauma patients with late-onset ventilator-associated pneumonia and these risk factors, empiric antibiotic therapy should include agents active against S. maltophilia.

Central venous catheter and Stenotrophomonas maltophilia bacteremia in cancer patients

“…8,30 Furthermore, critically ill patients are usually on mechanical ventilation and have an indwelling urinary catheter, which are 2 major sources of secondary S. maltophilia bacteremia reported to be associated with ventilatorassociated pneumonias and urinary tract infections, respectively, which are the leading causes of nosocomial infections in critically ill patients. 13,14 However, the association between secondary S. maltophilia and pneumonia noted in the current study could be related to the definitions we used whereby patients with S. maltophilia bacteremia and pneumonia were considered to have secondary bacteremia.…”

“…3,4 Infection with this pathogen commonly manifests as bacteremia, [1][2][3][4][5][6][7][8][9][10] although it can cause a wide spectrum of other infections as well. [11][12][13][14][15][16][17][18][19][20][21] Several studies have identified major risk factors for the infection, including neutropenia, prolonged hospitalization, previous antibiotic use, steroid use, mechanical ventilator support, and the use of medical devices such as prosthetic heart valves, urinary catheters, and indwelling central venous catheters (CVCs). [1][2][3][4][5][6][7][8][9][10]17,18 However, to our knowledge very little information is available regarding how often CVCs are the source of the bacteremia.…”

Stenotrophomonas maltophilia Infections in Adults: Primary Bacteremia and Pneumonia

“…Stenotrophomonas maltophilia pneumonia-associated mortality was previously reported as 23% -44%. (4,(13)(14)(15). Stenotrophomonas maltophilia bacteremia was reported as 21% -51% (8,(16)(17)(18)(19)(20).…”

Hospital-acquired pneumonia: coverage and treatment adequacy of current guidelines

“…In fact, this microorganism and other nonfermenting Gram-negative bacilli are not mentioned in the lists of the ATS guideline and the Trouillet classification. A recent study [27], reports a number of risk factors for nosocomial pneumonia by S. maltophilia in trauma patients (cefepime exposure, tracheostomy, pulmonary contusion and increased morbidity) and suggests the association of an agent with activity against this microorganism (preferably TMP-SMZ) when these conditions are present. New guidelines should also cover this problem.…”