Ventilator-associated pneumonia due to Stenotrophomonas maltophilia: Risk factors and outcome

Saied, Wafa Ibn; Merceron, Sybille; Schwebel, Carole; Monnier, Alban Le; Oziel, Johana; Garrouste-Orgeas, Maïté; Marcotte, Guillaume; Ruckly, Stéphane; Souweine, Bertrand; Darmon, Michaël; Bouadma, Lila; Montmollin, Étienne de; Mourvillier, Bruno; Reignier, Jean; Papazian, Laurent; Siami, Shidasp; Azoulay, Élie; Bédos, Jean‐Pierre; Timsit, Jean‐François

doi:10.1016/j.jinf.2019.10.021

Cited by 47 publications

(62 citation statements)

References 28 publications

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“…When interpreting the therapeutic effect of tigecycline in the treatment of S. maltophilia VAP, an important factor that needs to be considered is polymicrobial infection, as this reportedly accounted for 54.4–73.3% of S. maltophilia pneumonia in several studies [ 4 , 39 , 52 , 53 ]. In the present study, a similar result was also demonstrated, as 70.7% of patients were documented with polymicrobial infection.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, P. aeruginosa is naturally resistant against tigecycline [ 35 ]. Therefore, it is better not to recommend the use of tigecycline in polymicrobial S. maltophilia VAP, as the role of co-isolated pathogens in clinical course is still unclear, despite the studies that indicated no association between mortality and polymicrobial infection [ 4 , 39 , 52 ]. Paradoxically, the indication of using tigecycline to treat S. maltophilia VAP in the present study is usually the co-isolation of multidrug-resistant or carbapenem-resistant bacteria.…”

Section: Discussionmentioning

confidence: 99%

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Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study

et al. 2021

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Introduction Tigecycline is a potential alternative to trimethoprim–sulfamethoxazole in treating Stenotrophomonas maltophilia infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of S. maltophilia infections is scarce. In this study, we assessed the efficacy of tigecycline treating ventilator-associated pneumonia (VAP) due to S. maltophilia in comparison with fluoroquinolones. Methods This is a multicenter retrospective cohort study of patients admitted between January 2017 and December 2020 with the diagnosis of VAP caused by S. maltophilia receiving either tigecycline or fluoroquinolones as the definitive therapy ≥ 48 h. Clinical outcomes including 28-day mortality, clinical cure and microbiological cure were analyzed. Results Of 82 patients with S. maltophilia VAP included, 46 received tigecycline, and 36 received fluoroquinolones; 70.7% of patients had polymicrobial pneumonia, and the appropriate empiric therapy was applied to only 14.6% of patients. The overall 28-day mortality was 39%. Compared with patients receiving fluoroquinolones, tigecycline therapy resulted in worse clinical cure (32.6% vs. 63.9%, p = 0.009) and microbiological cure (28.6% vs. 59.1%, p = 0.045), while there was no statistical difference between 28-day mortality (47.8% vs. 27.8%, p = 0.105) in the two groups. Similar results were also shown in the inverse probability of treatment weighted univariable regression model and multivariable regression model. Conclusions The standard dose of tigecycline therapy was associated with a lower clinical and microbiological cure rate but not associated with an increased 28-day mortality in patients with S. maltophilia VAP compared with fluoroquinolones. Considering the unfavorable clinical outcomes, we therefore recommend against using the standard dose of tigecycline in treating S. maltophilia VAP unless new clinical evidence emerges. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00516-5.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study

et al. 2021

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“…S. maltophilia is a multidrug resistant gram-negative bacillus mostly seen in clinical practice as an opportunistic pathogen predominantly in mechanically ventilated patients [ 13 ]. It is responsible for approximately 6% of the VAPs that usually occur after a prolonged duration of mechanical ventilation [ 14 ]. Prior exposure to broad-spectrum antibiotics, including cefepime, has been significantly associated with VAP due to S. maltophilia, as was the case in our patient [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is responsible for approximately 6% of the VAPs that usually occur after a prolonged duration of mechanical ventilation [ 14 ]. Prior exposure to broad-spectrum antibiotics, including cefepime, has been significantly associated with VAP due to S. maltophilia, as was the case in our patient [ 14 , 15 ]. The drug of choice for its treatment has been TMP/SMX because it has the most reliable in vitro activity against the organism and its extensive drug resistance [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Renal Transplant Recipient with Concurrent COVID-19 and Stenotrophomonas maltophilia Pneumonia Treated with Trimethoprim/Sulfamethoxazole Leading to Acute Kidney Injury: A Therapeutic Dilemma

et al. 2020

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Patient: Male, 64-year-old Final Diagnosis: COVID-19 pneumonia Symptoms: Cough • fever • shortness of breath Medication: — Clinical Procedure: — Specialty: Critical Care Medicine • Pulmonology Objective: Rare co-existance of disease or pathology Background: Although coronavirus disease 2019 (COVID-19) manifests primarily as a lung infection, its involvement in acute kidney injury (AKI) is gaining recognition and is associated with increased morbidity and mortality. Concurrent infection, which may require administration of a potentially nephrotoxic agent, can worsen AKI and lead to poor outcomes. Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus associated with nosocomial infections, especially in severely immunocompromised and debilitated patients. Trimethoprim/sulfa-methoxazole combination (TMP/SMX) is considered the treatment of choice but can itself lead to AKI, posing a significant challenge in the management of patients with concomitant COVID-19 and S . maltophilia pneumonia. Case Report: A 64-year-old male with end-stage renal disease and post renal transplant presented with severe respiratory symptoms of COVID-19 and was intubated upon admission. His renal functions were normal at the time of admission. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia requiring administration of TMP/SMX. However, TMP/SMX led to the development of AKI, which continued to worsen despite appropriate management including hemodialysis. This coincided with and most likely resulted in the patient’s clinical deterioration and ultimate death. Conclusions: The etiology of kidney disease involvement in patients with COVID-19 is still evolving and appears to be multifactorial. The condition can significantly worsen especially when nephrotoxic agents are given, probably due to a cumulative or synergistic effect. Great caution should be taken when administering nephrotoxic agents in the setting of COVID-19 as it can lead to adverse patient outcomes.

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“…Among patients with bacteremia, a higher Charlson comorbidity index and indwelling venous catheterization may predispose to infection by quinolone-resistant strains of S. maltophilia, which in turn may be associated with a significant risk of mortality (6). Thus, antibiotic treatment of respiratory, or other, infections caused by S. maltophilia may be compromised (11).…”

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confidence: 99%

In Vitro Activity and In Vivo Efficacy of Cefiderocol against Stenotrophomonas maltophilia

Nakamura

Oota

Matsumoto

et al. 2021

Antimicrob Agents Chemother

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Cefiderocol is a novel siderophore cephalosporin antibiotic with broad coverage against difficult-to-treat Gram-negative bacteria, including those resistant to carbapenems. Its activity against Stenotrophomonas maltophilia was investigated in vitro against clinical isolates and in lung infection models using strains either resistant (SR202006) or susceptible (SR201934, SR200614) to trimethoprim/sulfamethoxazole. Cefiderocol demonstrated potent in vitro activity against all 217 S. maltophilia clinical isolates tested (MIC50: 0.063 μg/mL, MIC90: 0.25 μg/mL). Cefiderocol also demonstrated low MICs against the trimethoprim/sulfamethoxazole-resistant S. maltophilia strains (i.e. SR202006: MIC=0.125 μg/mL). In a neutropenic mouse lung infection model, cefiderocol (30 mg/kg and 100 mg/kg) demonstrated a significant, dose-dependent reduction in the lung viable bacteria cell count compared with untreated controls in S. maltophilia infection and was the only antibiotic tested to show a similar significant effect in a trimethoprim/sulfamethoxazole-resistant S. maltophilia infection. In immunocompetent rat lung infection models of S. maltophilia, humanized dosing of cefiderocol (2 g every 8 hours) and meropenem (1 g every 8 hours) revealed pharmacokinetic profiles similar to those in human subjects and the humanized cefiderocol dosing significantly reduced the lung viable bacteria cell count compared with baseline controls, which received no intervention. Together, the results from these studies suggest that cefiderocol could provide an effective alternative treatment option for S. maltophilia infections in the lower respiratory tract, particularly strains resistant to empiric antibiotics, such as trimethoprim/sulfamethoxazole or minocycline.

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Ventilator-associated pneumonia due to Stenotrophomonas maltophilia: Risk factors and outcome

Cited by 47 publications

References 28 publications

Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study

Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study

Renal Transplant Recipient with Concurrent COVID-19 and Stenotrophomonas maltophilia Pneumonia Treated with Trimethoprim/Sulfamethoxazole Leading to Acute Kidney Injury: A Therapeutic Dilemma

In Vitro Activity and In Vivo Efficacy of Cefiderocol against Stenotrophomonas maltophilia

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