Abstract
The importance of Stenotrophomonas maltophilia (SMA) as an etiologic frequently polyresistant pathogen in severe nosocomial infections has increased. In our prospective study we evaluated the risk factors of nosocomial infections by SMA in our internal intensive care unit (ICU) over a one year period from July 1997 to June 1998. 111 patients (80 men, 31 women, mean age +/- SD: 58.0 +/- 13.3 years) were treated for more than 5 days in the ICU. SMA were cultured in 16/111 patients (13 men, three women, mean age 57.8 +/- 3.4 years) out of bronchial secretions (68%), sputum (19%) and pleural fluid (13%). Univariate analysis resulted in 15 different risk factors (p < 0.05); however, multivariate analysis provided three independent risk factors: chronic obstructive pulmonary disease (OR 95% CI [1.91; infinity]), length of stay in the ICU (OR 95% CI [1.07; 1.26]) and therapy with carbapenems before admittance to ICU (OR 95% CI [0.56; 153]). Four of 16 patients died due to an SMA-infection, two by purulent exacerbations of a chronic bronchitis and two by sepsis. Molecular typing of 18 SMA isolates in 15 patients resulted in 9 different genetic types and a clonal dissemination could only be confirmed in three patients. In respiratory ICU SMA infections are favored by severe COPD, length of stay in the ICU and by selection pressure of applicated antibiotics, especially carbapenems.
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