Abstract
Stenotrophomonas maltophilia is an important nosocomial bacterial pathogen, as is Pseudomonas aeruginosa. Differentiation of these bacteria as bacteremic agents is critical in the clinical setting and to define a therapeutic strategy; however, the associated factors and prognosis for S. maltophilia bacteremia have not been fully evaluated to adequately characterize these factors. We first conducted a matched case-control study to clarify these questions. A total of 30 case patients with S. maltophilia bacteremia were compared with 30 control patients with P. aeruginosa bacteremia between January 2005 and August 2014, according to matching criteria based on underlying disease, age, and gender. The 30-day mortality rate for the case patients (53.3%) was significantly higher than that of the control group (30.0%) (P = 0.047, using the log-rank test). Conditional logistic regression analysis showed that the predisposing factors specific for the detection of S. maltophilia bacteremia were indwelling artificial products other than a central venous catheter, ICU stay, and previous use of anti-MRSA drugs. The high severity of illness was associated with mortality in both case and control patients. Interestingly, inappropriate antimicrobial treatment was an additional independent risk factor for mortality in only the case patients with S. maltophilia bacteremia (odds ratio = 13.64, P = 0.048). Monotherapy with fluoroquinolones inactive against the S. maltophilia isolates was mainly responsible for the inappropriate treatment. These results suggest that more precise prediction and more appropriate treatment might improve the prognosis of patients with S. maltophilia bacteremia.
Highlights
Stenotrophomonas maltophilia has emerged as an important pathogen that induces nosocomial infections [1]
A total of 30 case patients with S. maltophilia bacteremia were matched with 30 control patients with P. aeruginosa bacteremia for underlying disease, age, and gender (Table 1)
It is possible to assume that the clinical settings are similar between the hospitalized patients with S. maltophilia and P. aeruginosa bacteremia
Summary
Stenotrophomonas maltophilia has emerged as an important pathogen that induces nosocomial infections [1]. Risk Factors Associated with Stenotrophomonas maltophilia Bacteremia setting, similar to those caused by P. aeruginosa [2,3]. In a clinical setting that predisposes patients to S. maltophilia bacteremia, the differentiation between these two causative agents is critical. Various risk factors and mortality rates were obtained using different control groups [4,5,6,7,8]. Adequate matching eliminates the influence of potentially confounding factors for underlying diseases and, in our study, it helped to more practically characterize the predisposing factors for S. maltophilia bacteremia and its prognosis in clinical settings similar to those that favor P. aeruginosa bacteremia. We first conducted a matched case-control study using control patients with P. aeruginosa bacteremia. The risk factors for mortality of patients with bacteremia were evaluated
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