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European Journal of Clinical Microbiology & Infectious Diseases

Published in:

01-07-2012 | Article

Stenotrophomonas maltophilia in the respiratory tract of medical intensive care unit patients

Authors: B. Saugel, K. Eschermann, R. Hoffmann, A. Hapfelmeier, C. Schultheiss, V. Phillip, F. Eyer, K.-L. Laugwitz, R. M. Schmid, W. Huber

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 7/2012

Abstract

The purpose of this study was to investigate characteristics of critically ill patients with Stenotrophomonas maltophilia (S. maltophilia) isolated from the respiratory tract, to identify risk factors for S. maltophilia-pneumonia and intensive care unit (ICU) mortality and to analyze antibiotic susceptibility of S. maltophilia. This was a retrospective analysis of 64 medical ICU patients with S. maltophilia in the respiratory tract. Thirty-six patients fulfilled the criteria for diagnosis of pneumonia. A significantly higher lung injury score (LIS) was observed in patients with pneumonia compared to patients with colonization (p = 0.010). Independent risk factors for S. maltophilia-pneumonia were higher Sequential Organ Failure Assessment (SOFA) score (p = 0.009) and immunosuppression (p = 0.014). Patients with S. maltophilia-pneumonia had higher ICU mortality within a 28-day follow-up (p = 0.040) and higher hospital mortality (p = 0.018) than patients with colonization. The highest antibiotic susceptibility rates were observed to trimethoprim-sulfamethoxazole, tigecycline, and moxifloxacin. Higher SOFA score when S. maltophilia was isolated (p = 0.001) and development of renal failure (p = 0.021) were independent risk factors for ICU mortality. Higher SOFA score and immunosuppression are independent risk factors for S. maltophilia-pneumonia. Patients with S. maltophilia-pneumonia have a significantly higher ICU mortality within a 28-day follow-up, hospital mortality and LIS compared to patients with S. maltophilia-colonization.

Hugh R, Ryschenkow E (1961) Pseudomonas maltophilia, an alcaligenes-like species. J Gen Microbiol 26:123–132PubMed

Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34(2):344–353PubMedCrossRef

Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, Oh MD, Choe KW (2005) Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother 49(2):760–766PubMedCrossRef

Looney WJ, Narita M, Muhlemann K (2009) Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis 9(5):312–323PubMedCrossRef

Senol E (2004) Stenotrophomonas maltophilia: the significance and role as a nosocomial pathogen. J Hosp Infect 57(1):1–7PubMedCrossRef

Sanchez MB, Hernandez A, Martinez JL (2009) Stenotrophomonas maltophilia drug resistance. Future Microbiol 4:655–660PubMedCrossRef

Crossman LC, Gould VC, Dow JM, Vernikos GS, Okazaki A, Sebaihia M, Saunders D, Arrowsmith C, Carver T, Peters N, Adlem E, Kerhornou A, Lord A, Murphy L, Seeger K, Squares R, Rutter S, Quail MA, Rajandream MA, Harris D, Churcher C, Bentley SD, Parkhill J, Thomson NR, Avison MB (2008) The complete genome, comparative and functional analysis of Stenotrophomonas maltophilia reveals an organism heavily shielded by drug resistance determinants. Genome Biol 9(4):R74PubMedCrossRef

Nicodemo AC, Paez JI (2007) Antimicrobial therapy for Stenotrophomonas maltophilia infections. Eur J Clin Microbiol Infect Dis 26(4):229–237PubMedCrossRef

Ba BB, Feghali H, Arpin C, Saux MC, Quentin C (2004) Activities of ciprofloxacin and moxifloxacin against Stenotrophomonas maltophilia and emergence of resistant mutants in an in vitro pharmacokinetic-pharmacodynamic model. Antimicrob Agents Chemother 48(3):946–953PubMedCrossRef

10.

Zhang L, Li XZ, Poole K (2001) Fluoroquinolone susceptibilities of efflux-mediated multidrug-resistant Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Burkholderia cepacia. J Antimicrob Chemother 48(4):549–552PubMedCrossRef

11.

Apisarnthanarak A, Mayfield JL, Garison T, McLendon PM, DiPersio JF, Fraser VJ, Polish LB (2003) Risk factors for Stenotrophomonas maltophilia bacteremia in oncology patients: a case-control study. Infect Control Hosp Epidemiol 24(4):269–274PubMedCrossRef

12.

Krcmery V, Trupl J, Svetlansky I (2001) Susceptibility to antimicrobial agents of Stenotrophomonas maltophilia isolated from patients with cancer and bacteremia. Clin Infect Dis 32(11):1656PubMedCrossRef

13.

Micozzi A, Venditti M, Monaco M, Friedrich A, Taglietti F, Santilli S, Martino P (2000) Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies. Clin Infect Dis 31(3):705–711PubMedCrossRef

14.

Yeshurun M, Gafter-Gvili A, Thaler M, Keller N, Nagler A, Shimoni A (2010) Clinical characteristics of Stenotrophomonas maltophilia infection in hematopoietic stem cell transplantation recipients: a single center experience. Infection 38 (3):211–215

15.

Chaplow R, Palmer B, Heyderman R, Moppett J, Marks DI (2010) Stenotrophomonas maltophilia bacteraemia in 40 haematology patients: risk factors, therapy and outcome. Bone Marrow Transplant 45 (6):1109–1110

16.

Waters V, Yau Y, Prasad S, Lu A, Atenafu E, Crandall I, Tom S, Tullis E, Ratjen F (2011) Stenotrophomonas maltophilia in cystic fibrosis: serologic response and effect on lung disease. Am J Respir Crit Care Med 183(5):635–40

17.

Razvi S, Quittell L, Sewall A, Quinton H, Marshall B, Saiman L (2009) Respiratory microbiology of patients with cystic fibrosis in the United States, 1995 to 2005. Chest 136(6):1554–1560PubMedCrossRef

18.

Chen CY, Tsay W, Tang JL, Tien HF, Chen YC, Chang SC, Hsueh PR (2010) Epidemiology of bloodstream infections in patients with haematological malignancies with and without neutropenia. Epidemiol Infect 138 (7):1044–1051

19.

Shi SH, Kong HS, Jia CK, Zhang WJ, Xu J, Wang WL, Shen Y, Zhang M, Zheng SS (2009) Risk factors for pneumonia caused by multidrug-resistant Gram-negative bacilli among liver recipients. Clin Transplant 24(6):758–65CrossRef

20.

Calza L, Manfredi R, Chiodo F (2003) Stenotrophomonas (Xanthomonas) maltophilia as an emerging opportunistic pathogen in association with HIV infection: a 10-year surveillance study. Infection 31(3):155–161PubMed

21.

Leung C, Drew P, Azzopardi EA (2010) Extended multidrug-resistant Stenotrophomonas maltophilia septicemia in a severely burnt patient. J Burn Care Res 31(6):966

22.

Labarca JA, Leber AL, Kern VL, Territo MC, Brankovic LE, Bruckner DA, Pegues DA (2000) Outbreak of Stenotrophomonas maltophilia bacteremia in allogenic bone marrow transplant patients: role of severe neutropenia and mucositis. Clin Infect Dis 30(1):195–197PubMedCrossRef

23.

Lai CH, Wong WW, Chin C, Huang CK, Lin HH, Chen WF, Yu KW, Liu CY (2006) Central venous catheter-related Stenotrophomonas maltophilia bacteraemia and associated relapsing bacteraemia in haematology and oncology patients. Clin Microbiol Infect 12(10):986–991PubMedCrossRef

24.

Lai CH, Chi CY, Chen HP, Chen TL, Lai CJ, Fung CP, Yu KW, Wong WW, Liu CY (2004) Clinical characteristics and prognostic factors of patients with Stenotrophomonas maltophilia bacteremia. J Microbiol Immunol Infect 37(6):350–358PubMed

25.

Elting LS, Bodey GP (1990) Septicemia due to Xanthomonas species and non-aeruginosa Pseudomonas species: increasing incidence of catheter-related infections. Medicine (Baltimore) 69(5):296–306

26.

Friedman ND, Korman TM, Fairley CK, Franklin JC, Spelman DW (2002) Bacteraemia due to Stenotrophomonas maltophilia: an analysis of 45 episodes. J Infect 45(1):47–53PubMedCrossRef

27.

Nseir S, Di Pompeo C, Brisson H, Dewavrin F, Tissier S, Diarra M, Boulo M, Durocher A (2006) Intensive care unit-acquired Stenotrophomonas maltophilia: incidence, risk factors, and outcome. Crit Care 10(5):R143PubMedCrossRef

28.

Hanes SD, Demirkan K, Tolley E, Boucher BA, Croce MA, Wood GC, Fabian TC (2002) Risk factors for late-onset nosocomial pneumonia caused by Stenotrophomonas maltophilia in critically ill trauma patients. Clin Infect Dis 35(3):228–235PubMedCrossRef

29.

Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138(3):720–723PubMed

30.

Falagas ME, Kastoris AC, Vouloumanou EK, Rafailidis PI, Kapaskelis AM, Dimopoulos G (2009) Attributable mortality of Stenotrophomonas maltophilia infections: a systematic review of the literature. Future Microbiol 4:1103–1109PubMedCrossRef

31.

Barchitta M, Cipresso R, Giaquinta L, Romeo MA, Denaro C, Pennisi C, Agodi A (2009) Acquisition and spread of Acinetobacter baumannii and Stenotrophomonas maltophilia in intensive care patients. Int J Hyg Environ Health 212(3):330–337PubMedCrossRef

32.

Tseng CC, Fang WF, Huang KT, Chang PW, Tu ML, Shiang YP, Douglas IS, Lin MC (2009) Risk factors for mortality in patients with nosocomial Stenotrophomonas maltophilia pneumonia. Infect Control Hosp Epidemiol 30(12):1193–1202PubMedCrossRef

33.

Muder RR, Harris AP, Muller S, Edmond M, Chow JW, Papadakis K, Wagener MW, Bodey GP, Steckelberg JM (1996) Bacteremia due to Stenotrophomonas (Xanthomonas) maltophilia: a prospective, multicenter study of 91 episodes. Clin Infect Dis 22(3):508–512PubMedCrossRef

34.

Kwa AL, Low JG, Lim TP, Leow PC, Kurup A, Tam VH (2008) Independent predictors for mortality in patients with positive Stenotrophomonas maltophilia cultures. Ann Acad Med Singapore 37(10):826–830PubMed

35.

Elting LS, Khardori N, Bodey GP, Fainstein V (1990) Nosocomial infection caused by Xanthomonas maltophilia: a case-control study of predisposing factors. Infect Control Hosp Epidemiol 11(3):134–138PubMedCrossRef

36.

Calandra GB, Brown KR, Grad LC, Ahonkhai VI, Wang C, Aziz MA (1985) Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin. Am J Med 78(6A):73–78PubMedCrossRef

37.

Senol E, DesJardin J, Stark PC, Barefoot L, Snydman DR (2002) Attributable mortality of Stenotrophomonas maltophilia bacteremia. Clin Infect Dis 34(12):1653–1656PubMedCrossRef

38.

Jones RN, Pfaller MA, Marshall SA, Hollis RJ, Wilke WW (1997) Antimicrobial activity of 12 broad-spectrum agents tested against 270 nosocomial blood stream infection isolates caused by non-enteric gram-negative bacilli: occurrence of resistance, molecular epidemiology, and screening for metallo-enzymes. Diagn Microbiol Infect Dis 29(3):187–192PubMedCrossRef

39.

Clark NM, Patterson J, Lynch JP 3rd (2003) Antimicrobial resistance among gram-negative organisms in the intensive care unit. Curr Opin Crit Care 9(5):413–423PubMedCrossRef

40.

Valdezate S, Vindel A, Loza E, Baquero F, Canton R (2001) Antimicrobial susceptibilities of unique Stenotrophomonas maltophilia clinical strains. Antimicrob Agents Chemother 45(5):1581–1584PubMedCrossRef

Title: Stenotrophomonas maltophilia in the respiratory tract of medical intensive care unit patients
Authors: B. Saugel
K. Eschermann
R. Hoffmann
A. Hapfelmeier
C. Schultheiss
V. Phillip
F. Eyer
K.-L. Laugwitz
R. M. Schmid
W. Huber
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: European Journal of Clinical Microbiology & Infectious Diseases / Issue 7/2012
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI: https://doi.org/10.1007/s10096-011-1459-8

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