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Risk Factors for Mortality in Patients with Nosocomial Stenotrophomonas maltophilia Pneumonia

Published online by Cambridge University Press:  02 January 2015

Chia-Cheng Tseng ,
Wen-Feng Fang ,
Kuo-Tung Huang ,
Pei-Wen Chang ,
Mei-Lien Tu ,
Yi-Ping Shiang ,
I. S. Douglas  and
Meng-Chih Lin
Chia-Cheng Tseng
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Wen-Feng Fang
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan Department of Respiratory Care, Pulmonary Research Center, Chang Gung Institute of Technology, Chiayi, Taiwan
Kuo-Tung Huang
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Mei-Lien Tu
Affiliation:
Department of Respiratory Therapy, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Yi-Ping Shiang
Affiliation:
Department of Pharmacy, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
I. S. Douglas
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Colorado, Denver, Colorado
Meng-Chih Lin*
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan Department of Respiratory Care, Pulmonary Research Center, Chang Gung Institute of Technology, Chiayi, Taiwan
*
123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan 83301 (mengchih@adm.cgmh.org.tw)
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Abstract

Objective.

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

Design.

A retrospective, single-center, observational study.

Setting.

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.

Results.

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).

Conclusions.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 12 , December 2009 , pp. 1193 - 1202
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

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;33:129–135.CrossRefGoogle ScholarPubMed
2.Iregui, MG, Kollef, MH. Ventilator-associated pneumonia complicating the acute respiratory distress syndrome. Semin Respir Crit Care Med 2001; 22:317–326.CrossRefGoogle ScholarPubMed
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;157:531–539.Google Scholar
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;33:1363–1368.CrossRefGoogle ScholarPubMed
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;134:281–287.CrossRefGoogle ScholarPubMed
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.Google Scholar
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;37:826–830.CrossRefGoogle ScholarPubMed
8.Ferrara, AM. Potentially multidrug-resistant non-fermentative Gram-negative pathogens causing nosocomial pneumonia. Int J Antimicrob Agents 2006;27:183–195.CrossRefGoogle ScholarPubMed
9.Spencer, RC. The emergence of epidemic, multiple-antibiotic-resistant Stenotrophomonas (Xanthomonas) maltophilia and Burkholderia (Pseudomonas) cepacia. J Hosp Infect 1995;30(Suppl):453–464.CrossRefGoogle ScholarPubMed
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;60:205–210.Google Scholar
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;26:13–20.Google Scholar
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;35:228–235.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
14.Pines, JM. Timing of antibiotics for acute, severe infections. Emerg Med Clin North Am 2008;26:245–257, vii.Google Scholar
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;40:373–383.CrossRefGoogle ScholarPubMed
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;37:359–365.Google Scholar
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;24:52–55.Google Scholar
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;28:134–141.Google Scholar
19.Maningo, E, Watanakunakorn, C. Xanthomonas maltophilia and Pseudomonas cepacia in lower respiratory tracts of patients in critical care units. J Infect 1995;31:89–92.Google Scholar
20.Combes, A, Figliolini, C, Trouillet, JL, et al.Incidence and outcome of polymicrobial ventilator-associated pneumonia. Chest 2002;121:1618–1623.CrossRefGoogle ScholarPubMed
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;10:22–24.Google Scholar
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;39:1011–1012.CrossRefGoogle Scholar
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;38:624–627.CrossRefGoogle ScholarPubMed
24.Paez, JI, Costa, SF. Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review. J Hosp Infect 2008;70:101–108.CrossRefGoogle ScholarPubMed
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;27:901–906.Google Scholar
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;24:4–9.Google ScholarPubMed
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;128:3233–3239.CrossRefGoogle ScholarPubMed
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;30:2251–2257.CrossRefGoogle ScholarPubMed
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;30:314–320.CrossRefGoogle ScholarPubMed
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;189:293–296.CrossRefGoogle ScholarPubMed
31.Leone, M, Garcin, F, Bouvenot, J, et al.Ventilator-associated pneumonia: breaking the vicious circle of antibiotic overuse. Crir Care Med 2007;35:379–385.Google Scholar
32.Luna, CM, Vujacich, P, Niederman, MS, et al.Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 1997;111:676–685.Google Scholar
33.Dembinski, R, Rossaint, R. Ventilator-associated pneumonia. Der Anaes-thesist 2008;57:825–842.Google ScholarPubMed
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;109:2615–2622.Google Scholar
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;62:889–894.Google Scholar
36.Safdar, A, Rolston, KV. Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clin Infect Dis 2007;45:1602–1609.Google Scholar
37.Yilmaz, M, Celik, AF, Mert, A. Successfully treated nosocomial Stenotrophomonas maltophilia bacteremia following desensitization to trimethoprim-sulfamethoxazole. J Infect Chemother 2007;13:122–123.Google Scholar
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;13:559–565.CrossRefGoogle ScholarPubMed
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; 59:1038–1039.Google Scholar
40.Al-Jasser, AM. Stenotrophomonas maltophilia resistant to trimethoprimsulfamethoxazole: an increasing problem. Ann Clin Microbiol Antimicrob 2006;5:23.CrossRefGoogle ScholarPubMed
41.Looney, WJ, Narita, M, Muhlemann, K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis 2009;9:312–323.CrossRefGoogle ScholarPubMed