Skip to main content Accessibility help

Risk Factors for Mortality in Patients with Nosocomial Stenotrophomonas maltophilia Pneumonia

  • Chia-Cheng Tseng (a1), Wen-Feng Fang (a1) (a2), Kuo-Tung Huang (a1), Pei-Wen Chang, Mei-Lien Tu (a3), Yi-Ping Shiang (a4), I. S. Douglas (a5) and Meng-Chih Lin (a1) (a2)...



The aim of this study was to determine potential risk factors for mortality in patients with nosocomial Stenotrophomonas maltophilia pneumonia.


A retrospective, single-center, observational study.


A 2400-bed tertiary teaching hospital in southern Taiwan.

Patients and Methods.

This retrospective study evaluated patients (age, at least 18 years) with nosocomial pneumonia (S. maltophilia isolated from respiratory culture) who were seen at Kaohsiung Chang Gung Memorial Hospital over a 3-year period. A total of 406 patients (64% male, mean age ± standard deviation, 69.6 ± 14.93 years; mean duration of hospital stay ± standard deviation, 57.5 ± 39.47 days) were included.


Most index isolates (53.9%) were from the first sample cultured. Polymicrobial isolates were cultured from samples from 177 (43.6%) of the 406 study patients. The most common copathogen was Pseudomonas aeruginosa (53.11% of isolates). The all-cause hospital mortality rate was 42.6% (173 deaths among 406 patients). Survivors had a shorter time from admission to a positive index culture result than did nonsurvivors (26.1 vs 31.7 days; P = .04). Mortality was significantly higher among patients with malignancy (adjusted odds ratio [AOR], 2.48; 95% confidence interval [CI], 1.52–4.07; P < .001 ), renal disease (AOR, 2.6; 95% CI, 1.51–4.47; P = .001), intensive care unit stay (AOR, 1.72; 95% CI, 1.1–2.7; P = .018), and inadequate initial empirical antibiotic therapy (AOR, 2.17; 95% CI, 1.4–3.38; P = .001).


S. maltophilia pneumonia is associated with a high mortality rate and is commonly associated with concomitant polymicrobial colonization or infection. Underlying comorbidities and inadequate initial empirical antibiotic therapy substantially account for increased mortality rates.


Corresponding author

123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan 83301 (


Hide All
1.Leroy, O, d'Escrivan, T, Devos, P, Dubreuil, L, Kipnis, E, Georges, H. Hospital-acquired pneumonia in critically ill patients: factors associated with episodes due to imipenem-resistant organisms. Infection 2005;33:129135.
2.Iregui, MG, Kollef, MH. Ventilator-associated pneumonia complicating the acute respiratory distress syndrome. Semin Respir Crit Care Med 2001; 22:317326.
3.Trouillet, JL, Chastre, J, Vuagnat, A, et al.Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Resp Crit Care Med 1998;157:531539.
4.Valles, J, Pobo, A, Garcia-Esquirol, O, Mariscal, D, Real, J, Fernandez, R. Excess ICU mortality attributable to ventilator-associated pneumonia: the role of early vs late onset. Intensive Care Med 2007;33:13631368.
5.Kollef, KE, Schramm, GE, Wills, AR, Reichley, RM, Micek, ST, Kollef, MH. Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibiotic-resistant gram-negative bacteria. Chest 2008;134:281287.
6.Wolkewitz, M, Vonberg, RP, Grundmann, H, et al.Risk factors for the development of nosocomial pneumonia and mortality on intensive care units: application of competing risks models. Crit Care 2008;12:R44.
7.Kwa, AL, Low, JG, Lim, TP, Leow, PC, Kurup, A, Tarn, VH. Independent predictors for mortality in patients with positive Stenotrophomonas mal-tophilia cultures. Ann Acad Med Singapore 2008;37:826830.
8.Ferrara, AM. Potentially multidrug-resistant non-fermentative Gram-negative pathogens causing nosocomial pneumonia. Int J Antimicrob Agents 2006;27:183195.
9.Spencer, RC. The emergence of epidemic, multiple-antibiotic-resistant Stenotrophomonas (Xanthomonas) maltophilia and Burkholderia (Pseudomonas) cepacia. J Hosp Infect 1995;30(Suppl):453464.
10.Tan, CK, Liaw, SJ, Yu, CI, Teng, LJ, Hsueh, PR. Extensively drug-resistant Stenotrophomonas maltophilia in a tertiary care hospital in Taiwan: microbiologic characteristics, clinical features, and outcomes. Diagn Microbiol Infect Dis 2008;60:205210.
11.Aisenberg, G, Rolston, KV, Dickey, BF, Kontoyiannis, DP, Raad, II, Safdar, A. Stenotrophomonas maltophilia pneumonia in cancer patients without traditional risk factors for infection, 1997-2004. Eur J Clin Microbiol Infect Dis 2007;26:1320.
12.Hanes, SD, Demirkan, K, Tolley, E, et al.Risk factors for late-onset nosocomial pneumonia caused by Stenotrophomonas maltophilia in critically ill trauma patients. Clin Infect Dis 2002;35:228235.
13.Nseir, S, Di Pompeo, C, Brisson, H, et al.Intensive care unit-acquired Stenotrophomonas maltophilia: incidence, risk factors, and outcome. Crir Care 2006;10:R143.
14.Pines, JM. Timing of antibiotics for acute, severe infections. Emerg Med Clin North Am 2008;26:245257, vii.
15.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.
16.Wang, WS, Liu, CP, Lee, CM, Huang, FY. Stenotrophomonas maltophilia bacteremia in adults: four years' experience in a medical center in northern Taiwan. Wei Mian Yu Gan Ran Za Zhi 2004;37:359365.
17.AJ, Morrison Jr, Hoffmann, KK, Wenzel, RP. Associated mortality and clinical characteristics of nosocomial Pseudomonas maltophilia in a university hospital. J Clin Microbiol 1986;24:5255.
18.Gopalakrishnan, R, Hawley, HB, Czachor, JS, Marken, RJ, Bernstein, JM. Stenotrophomonas maltophilia infection and colonization in the intensive care units of two community hospitals: a study of 143 patients. Heart Lung 1999;28:134141.
19.Maningo, E, Watanakunakorn, C. Xanthomonas maltophilia and Pseudomonas cepacia in lower respiratory tracts of patients in critical care units. J Infect 1995;31:8992.
20.Combes, A, Figliolini, C, Trouillet, JL, et al.Incidence and outcome of polymicrobial ventilator-associated pneumonia. Chest 2002;121:16181623.
21.Blahovâ, J, Krâlikovâ, K, Krcméry, V Sr, Chmelarovâ, E, Torsovd, V. Two nosocomial strains of Stenotrophomonas maltophilia transferring antibiotic resistance to Proteus mirabilis P-38 recipient strain. J Chemother 1998;10:2224.
22.Hupkova, M, Blahova, J, Kralikova, J, Krcmery, V. Transferable resistance to beta-lactams in a nosocomial strain of Xanthomonas maltophilia. Antimicrob Agents Chemother 1995;39:10111012.
23.Vartivarian, S, Anaissie, E, Bodey, G, Sprigg, H, Rolston, K. A changing pattern of susceptibility of Xanthomonas maltophilia to antimicrobial agents: implications for therapy. Antimicrob Agents Chemother 1994;38:624627.
24.Paez, JI, Costa, SF. Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review. J Hosp Infect 2008;70:101108.
25.Garcia Paez, JI, Tengan, FM, Barone, AA, Levin, AS, Costa, SF. Factors associated with mortality in patients with bloodstream infection and pneumonia due to Stenotrophomonas maltophilia. Eur J Clin Microbiol Infect Dis 2008;27:901906.
26.del Toro, MD, Rodriguez-Bano, J, Martinez-Martinez, L, et al.Epidemiology, clinical features and prognosis of infections due to Stenotrophomonas maltophilia. Enfermedades Infecciosas y Microbiologia Clinica 2006;24:49.
27.Falguera, M, Pifarre, R, Martin, A, Sheikh, A, Moreno, A. Etiology and outcome of community-acquired pneumonia in patients with diabetes mellitus. Chest 2005;128:32333239.
28.Kornum, JB, Thomsen, RW, Riis, A, Lervang, HH, Schonheyder, HC, Sorensen, HT. Type 2 diabetes and pneumonia outcomes: a population-based cohort study. Diabetes Care 2007;30:22512257.
29.Nseir, S, Di Pompeo, C, Jozefowicz, E, et al.Relationship between tracheotomy and ventilator-associated pneumonia: a case control study. Eur Respir J 2007;30:314320.
30.Moller, MG, Slaikeu, JD, Bonelli, P, Davis, AT, Hoogeboom, JE, Bonnell, BW. Early tracheostomy versus late tracheostomy in the surgical intensive care unit. Am J Surg 2005;189:293296.
31.Leone, M, Garcin, F, Bouvenot, J, et al.Ventilator-associated pneumonia: breaking the vicious circle of antibiotic overuse. Crir Care Med 2007;35:379385.
32.Luna, CM, Vujacich, P, Niederman, MS, et al.Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 1997;111:676685.
33.Dembinski, R, Rossaint, R. Ventilator-associated pneumonia. Der Anaes-thesist 2008;57:825842.
34.Ansari, SR, Hanna, H, Hachem, R, Jiang, Y, Rolston, K, Raad, I. Risk factors for infections with multidrug-resistant Stenotrophomonas maltophilia in patients with cancer. Cancer 2007;109:26152622.
35.Falagas, ME, Valkimadi, PE, Huang, YT, Matthaiou, DK, Hsueh, PR. Therapeutic options for Stenotrophomonas maltophilia infections beyond co-trimoxazole: a systematic review. J Antimicrob Chemother 2008;62:889894.
36.Safdar, A, Rolston, KV. Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clin Infect Dis 2007;45:16021609.
37.Yilmaz, M, Celik, AF, Mert, A. Successfully treated nosocomial Stenotrophomonas maltophilia bacteremia following desensitization to trimethoprim-sulfamethoxazole. J Infect Chemother 2007;13:122123.
38.Toleman, MA, Bennett, PM, Bennett, DM, Jones, RN, Walsh, TR. Global emergence of trimethoprim/sulfamethoxazole resistance in Stenotrophomonas maltophilia mediated by acquisition of sul genes. Emerg Infect Dis 2007;13:559565.
39.Chang, LL, Lin, HH, Chang, CY, Lu, PL. Increased incidence of class 1 integrons in trimethoprim/sulfamethoxazole-resistant clinical isolates of Stenotrophomonas maltophilia. J Antimicrob Chemother 2007; 59:10381039.
40.Al-Jasser, AM. Stenotrophomonas maltophilia resistant to trimethoprimsulfamethoxazole: an increasing problem. Ann Clin Microbiol Antimicrob 2006;5:23.
41.Looney, WJ, Narita, M, Muhlemann, K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis 2009;9:312323.

Risk Factors for Mortality in Patients with Nosocomial Stenotrophomonas maltophilia Pneumonia

  • Chia-Cheng Tseng (a1), Wen-Feng Fang (a1) (a2), Kuo-Tung Huang (a1), Pei-Wen Chang, Mei-Lien Tu (a3), Yi-Ping Shiang (a4), I. S. Douglas (a5) and Meng-Chih Lin (a1) (a2)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed