Skip to main content

Advertisement

SpringerLink
Log in

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

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lai CH, Chi CY, Chen HP et al (2004) Clinical characteristics and prognostic factors of patients with Stenotrophomonas maltophilia bacteremia. J Microbiol Immunol Infect 37:350–358

    PubMed  Google Scholar 

  2. Hanes SD, Demirkan K, Tolley E et al (2002) Risk factors for late-onset nosocomial pneumonia caused by Stenotrophomonas maltophilia in critically ill trauma patients. Clin Infect Dis 35:228–235

    Article  PubMed  Google Scholar 

  3. Muder RR, Harris AP, Muller S et al (1996) Bacteremia due to Stenotrophomonas (Xanthomonas) maltophilia: a prospective, multicenter study of 91 episodes. Clin Infect Dis 22:508–512

    PubMed  CAS  Google Scholar 

  4. Micozzi A, Venditti M, Monaco M et al (2000) Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies. Clin Infect Dis 31:705–711

    Article  PubMed  CAS  Google Scholar 

  5. Victor MA, Arpi M, Bruun B et al (1994) Xanthomonas maltophilia bacteremia in immunocompromised hematological patients. Scand J Infect Dis 26:163–170

    Article  PubMed  CAS  Google Scholar 

  6. Friedman ND, Korman TM, Fairley CK et al (2002) Bacteraemia due to Stenotrophomonas maltophilia: an analysis of 45 episodes. J Infect 45:47–53

    Article  PubMed  CAS  Google Scholar 

  7. Elting LS, Khardori N, Bodey GP et al (1990) Nosocomial infection caused by Xanthomonas maltophilia: a case–control study of predisposing factors. Infect Control Hosp Epidemiol 11:134–138

    Article  PubMed  CAS  Google Scholar 

  8. del Toro MD, Rodríguez-Baño J, Herrero M et al (2002) Clinical epidemiology of Stenotrophomonas maltophilia colonization and infection: a multicenter study. Medicine (Baltimore) 81:228–239

    Article  Google Scholar 

  9. Carmeli Y, Samore MH (1997) Comparison of treatment with imipenem vs. ceftazidime as a predisposing factor for nosocomial acquisition of Stenotrophomonas maltophilia: a historical cohort study. Clin Infect Dis 24:1131–1134

    Article  PubMed  CAS  Google Scholar 

  10. Denton M, Kerr KG (1998) Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. Clin Microbiol Rev 11:57–80

    PubMed  CAS  Google Scholar 

  11. Senol E, DesJardin J, Stark PC et al (2002) Attributable mortality of Stenotrophomonas maltophilia bacteremia. Clin Infect Dis 34:1653–1656

    Article  PubMed  Google Scholar 

  12. Wang WS, Liu CP, Lee CM et al (2004) Stenotrophomonas maltophilia bacteremia in adults: four years’ experience in a medical center in northern Taiwan. J Microbiol Immunol Infect 37:359–365

    PubMed  Google Scholar 

  13. del Toro MD, Rodríguez-Baño J, Martínez-Martínez L et al (2006) Características epidemiológicas, clínicas y pronósticas de la infección por Stenotrophomonas maltophilia. Enferm Infecc Microbiol Clin 24:4–9

    Article  PubMed  Google Scholar 

  14. Tsiodras S, Pittet D, Carmeli Y et al (2000) Clinical implications of Stenotrophomonas malthophilia resistant to trimethoprim-sulfamethoxazole: a study of 69 patients at 2 university hospitals. Scand J Infect Dis 32:651–656

    Article  PubMed  CAS  Google Scholar 

  15. Nseir S, Di Pompeo C, Brisson H et al (2006) Intensive care unit-acquired Stenotrophomonas maltophilia: incidence, risk factors, and outcome. Crit Care 10:R143, DOI 10.1186/cc5063

    Article  PubMed  Google Scholar 

  16. McCabe WR, Jackson GG (1962) Gram-negative bacteremia. I. Etiology and ecology. Arch Intern Med 110:847–855

    Google Scholar 

  17. Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710

    Article  PubMed  CAS  Google Scholar 

  18. Knaus WA, Draper EA, Wagner DP et al (1985) APACHE II: a severity of disease classification system. Crit Car Med 13:818–829

    Article  CAS  Google Scholar 

  19. Garner JS, Jarvis WR, Emori TG et al (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140

    Article  PubMed  CAS  Google Scholar 

  20. [No authors listed] (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874

  21. Clinical and Laboratory Standards Institute (CLSI) (2005) Performance standards for antimicrobial susceptibility testing. Fifteenth Informational Supplement M100-S15. CLSI, Wayne, PA

    Google Scholar 

  22. Aisenberg G, Rolston KV, Dickey BF et al (2007) Stenotrophomonas maltophilia pneumonia in cancer patients without traditional risk factors for infection, 1997–2004. Eur J Clin Microbiol Infect Dis 26:13–20

    Article  PubMed  CAS  Google Scholar 

  23. Metan U, Uzun O (2005) Impact of initial antimicrobial therapy in patients with bloodstream infections caused by Stenotrophomonas maltophilia. Antimicrob Agents Chemother 49:3980–3981

    Article  PubMed  CAS  Google Scholar 

  24. Morrison AJ Jr, Hoffmann KK, Wenzel RP (1986) Associated mortality and clinical characteristics of nosocomial Pseudomonas maltophilia in a university hospital. J Clin Microbiol 24:52–55

    PubMed  Google Scholar 

  25. Nicodemo AC, Garcia Paez JI (2007) Antimicrobial therapy for Stenotrophomonas maltophilia infections. Eur J Clin Microbiol Infect Dis 26:229–237

    Article  PubMed  CAS  Google Scholar 

  26. Boktour M, Hanna H, Ansari S et al (2006) Central venous catheter and Stenotrophomonas maltophilia bacteremia in cancer patients. Cancer 106:1967–1973

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, Hospital das Clinicas of the University of São Paulo Medical School, Av. Enéas de Carvalho Aguiar n° 500-2° Andar LIN: 47, CEP: 05410-000, São Paulo, Brazil

    J. I. Garcia Paez, F. M. Tengan, A. A. Barone, A. S. Levin & S. F. Costa

Authors
  1. J. I. Garcia Paez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. M. Tengan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. A. Barone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. S. Levin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. F. Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. I. Garcia Paez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Garcia Paez, J.I., Tengan, F.M., Barone, A.A. et al. Factors associated with mortality in patients with bloodstream infection and pneumonia due to Stenotrophomonas maltophilia . Eur J Clin Microbiol Infect Dis 27, 901–906 (2008). https://doi.org/10.1007/s10096-008-0518-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-008-0518-2

Keywords

Search

Navigation