Risk factors for mortality in patients with Stenotrophomonas maltophilia bacteremia and clinical impact of quinolone–resistant strains

Abstract

Background Stenotrophomonas maltophilia is an important nosocomial pathogen. This pathogen has intrinsic or acquired resistance to a number of antibiotics classes. Furthermore, Stenotrophomonas infections have been associated with high mortality, mainly in immunocompromised patients. Accordingly, we conducted a retrospective cohort study on the clinical data, microbiological characteristics, and outcomes of patients with S. maltophilia (SM) bacteremia. Methods A retrospective cohort study was conducted at two tertiary care referral hospitals in Seoul, South Korea. Data were collected between January 2006 and December 2015 from electric medical records . Our analysis aimed to identify the risk factors associated with crude mortality, as well as the predictive factors of quinolone-resistant strains in SM bacteremia patients. Results A total of 126 bacteremia patients were enrolled in the study. The mortality rate was 65.1%. On multivariable analysis, hypoalbuminemia (odds ratio [OR], 5.090; 95% confidence interval [CI], 1.321–19.621; P = 0.018), hematologic malignancy (OR, 35.567; 95% CI, 2.517–502.515; P = 0.008) and quinolone-resistant strains (OR, 7.785; 95% CI, 1.278–47.432; P = 0.026) were independent risk factors for mortality. Alternatively, usage of an empirical regimen with quinolone (OR, 0.172; 95% CI, 0.034–0.875; P = 0.034) was an independent protective factor for mortality. The multivariable analysis of predictive factors revealed that high Charlson comorbidity index (OR, 1.190; 95% CI, 1.040–1.361; P = 0.011) and indwelling of a central venous catheter (CVC) (OR, 3.303; 95% CI, 1.194–9.139; P = 0.021) were independent predisposing factors associated with quinolone-resistant strains in SM bacteremia patients. Conclusions Our findings suggest that a high Charlson comorbidity score and indwelling of a CVC were significantly independent predictors of quinolone-resistant strains in SM bacteremia patients . Therefore, we need to carefully consider the antibiotic use in SM bacteremia patients with these predictive factors. Electronic supplementary material The online version of this article (10.1186/s12879-019-4394-4) contains supplementary material, which is available to authorized users.

The phylogenetic landscape and nosocomial spread of the multidrug-resistant opportunist Stenotrophomonas maltophilia

“…S. maltophilia is believed to be a much less virulent pathogen relative to other nosocomials such as P. aeruginosa or S. aureus 39 . The establishment of human infection or colonisation with S. maltophilia is likely also strongly driven by the host factors such as the immune status while the role of pathogen genetic background or specific virulence mechanisms is still to be determined 40 . Collecting data on the host immune status or other predisposing factors will enable research in this area in the future.…”

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

“…15,17 Some previous studies found fluoroquinolone-resistant strain and inappropriate fluoroquinolone treatment when the organisms resistant to were factors predicting the non-survival outcome. 28,29 Although minocycline has demonstrated very promising in vitro activity against the isolates, this agent is unfortunately not presently available in Thailand.…”

Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

“…Antimicrobial therapy and removal of the CVC are crucial in the treatment of patients with suspected CRI. As retention of the CVC in patients with suspected CRI can result in treatment failure or recurrence of infection in spite of antibiotic therapy, CVC removal is encouraged in all patients with CRI whenever possible [1,21,38,86,[190][191][192]. Although CVC removal and reinsertion may be burdensome for cancer patients, early CVC removal is particularly encouraged in patients with deteriorating clinical state, sepsis, or septic shock and in case of severe complications such as endocarditis, septic thrombosis, abscess formations, or osteomyelitis [193].…”