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Factors associated with mortality in patients with bloodstream infection and pneumonia due to Stenotrophomonas maltophilia

  • J. I. Garcia PaezEmail author
  • F. M. Tengan
  • A. A. Barone
  • A. S. Levin
  • S. F. Costa
Article

Abstract

Severe infections caused by Stenotrophomonas maltophilia are associated with high mortality, and strategies to improve the clinical outcome for infected patients are needed. A retrospective cohort study of patients with bloodstream infection (BSIs) and pneumonia caused by S. maltophilia was conducted. Multivariate analysis was performed to access factors associated with 14-day mortality. A total of 60 infections were identified. Among these, eight (13%) were pneumonias and 52 were BSIs; 33.3% were primary, 13% were central venous catheter (CVC)-related and 40% were secondary BSIs. Fifty-seven (85%) patients had received previous antimicrobial therapy; 88% had CVC, 57% mechanical ventilation and 75% were in the intensive care unit at the onset of infection. Malignancy (45%) was the most frequent underlying disease. The mean of the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores was 17 and for the Sepsis-related Organ Failure Assessment (SOFA) score, it was 7 points. The overall and 14-day mortality were, respectively, 75% and 48%. Forty-seven (78%) patients were treated and, of these, 74% received trimethoprim-sulfamethoxazole. Independent risk factors associated with mortality were SOFA index >6 points (0.005) and septic shock (0.03). The Kaplan-Meier estimations curves showed that patients with APACHE II score >20 and SOFA score >10 had a survival chance of, respectively, less than 8% and less than 10% (P≤0.001) at 21 days after the first positive S. maltophilia culture. Our results suggest that the independent factors associated with outcome in patients with infection caused by S. maltophilia are septic shock and higher SOFA index.

Keywords

Septic Shock Central Venous Catheter Intensive Care Unit Patient Multiple Organ Dysfunction Syndrome Acinetobacter Baumannii 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

We thank Dr. Lorena Laborda and Dr. Maura S. Oliveira for their support in this study.

Transparency declarations

This study was approved by the ethics committee of the Hospital das Clínicas of the University of São Paulo Medical School, São Paulo, Brazil.

Potential conflicts of interest statement

All authors: no conflicts.

Financial support

All authors: no financial support.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • J. I. Garcia Paez
    • 1
    Email author
  • F. M. Tengan
    • 1
  • A. A. Barone
    • 1
  • A. S. Levin
    • 1
  • S. F. Costa
    • 1
  1. 1.Department of Infectious DiseasesHospital das Clinicas of the University of São Paulo Medical SchoolSão PauloBrazil

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