Risk factors for mortality in patients with Stenotrophomonas maltophilia infection in Hatyai Hospital

Authors

  • Watjanarat Nitchot -
  • Burin Arunyapongpaisan

Keywords:

Stenotrophomonas maltophilia, Risk factors, Mortality rate

Abstract

Stenotrophomonas maltophilia is a multidrug resistant bacterium that can cause nosocomial infection leading to high mortality rate. This study aimed to assess the risk factors for mortality and antibiotic use regarding S. maltophilia infection. A retrospective analytical study was performed by collecting patients with S. maltophilia infection between June 2015 and June 2018 from a hospital database. The SPSS Program reported correlation size of data with odds ratio and analyzed variable correlation using multivariate logistic regression. The data significantly differed with a p-value <0.05. Altogether, 404 patients with S. maltophilia infection were included; mean age 60.6 years and mostly males (67.8%). The most frequent infection types were respiratory tract, skin and soft tissue and urinary tract at 81.9, 5.7 and 4.5%, respectively. The susceptibility of microbes to trimethoprim /sulfamethoxazole, levofloxacin and sulbactam/cefoperazone were 90.6, 87.4 and 85.6%, respectively. The overall mortality rate was 19.9%. Based on univariate analysis, the variables significantly associated with mortality were heart disease (P=0.004), HIV positive (P=0.049), immunosuppressive therapy (P=0.014), indwelling catheter insertion (P=0.005), endotracheal intubation (P<0.001), central venous catheter insertion (P<0.001) and surgery (P=0.001). Based on multivariate analysis, the variables significantly associated with mortality were endotracheal intubation (P<0.001), central venous catheter insertion (P=0.002) and surgery (P<0.001). In conclusion, endotracheal intubation and central venous catheter insertion were significantly associated with mortality among patients with S. maltophilia infection. Microbes are still susceptible to trimethromprim/sulfamethoxazole which was the first line drug and to levofloxacin and sulbactam/cefoperazone as alternative agents.

References

Adegoke, A.A., Stenström, T.A., & Okoh, A.I. (2017). Stenotrophomonas maltophilia as an Emerging Ubiquitous Pathogen: Looking Beyond Contemporary Antibiotic Therapy. Frontiers in Microbiology. 30; 8:2276.

Al-Jasser, A.M. (2006). Stenotrophomonas maltophilia resistant to trimethoprim-sulfamethoxazole: an increasing problem. Annals of Clinical Microbiology and Antimicrobials. 18; 5:23.

Avison, M.B., Bennett, P.M., Higgins, C.S., von Heldreich, C.J., & Walsh, T.R. (2001). Plasmid location and molecular heterogeneity of the L1 and L2 beta-lactamase genes of Stenotrophomonas maltophilia. Antimicrobial Agents and Chemotherapy. 45(2), 413-419.

Brooke, J.S. (2021). Advances in the Microbiology of Stenotrophomonas maltophilia. Clinical Microbiology Reviews.16, 34(3).

Chang, Y.T., Lin, C.Y., Chen, Y.H., & Hsueh, P.R. (2015). Update on infections caused by Stenotrophomonas maltophilia with particular attention to resistance mechanisms and therapeutic options. Frontiers in Microbiology. 2; 6:893.

Falagas, M.E., Huang, Y.T., Hsueh, P.R., Matthaiou, D.K., & Valkimadi, P.E. (2008). Therapeutic options for Stenotrophomonas maltophilia infections beyond co-trimoxazole: a systematic review. Journal of Antimicrobial Chemotherapy. 62(5), 889-894.

Falagas, M.E., Kastoris, A.C., Vouloumanou, E.K., Rafailidis, P.I., Kapaskelis, A.M., & Dimopoulos G. (2009). Attributable mortality of Stenotrophomonas maltophilia infections: a systematic review of the literature. Future Microbiology. 4(9), 1103-1109.

Gajdács, M., & Urbán, E. (2019). Prevalence and Antibiotic Resistance of Stenotrophomonas maltophilia in Respiratory Tract Samples: A 10-Year Epidemiological Snapshot. Health Services Research & Managerial Epidemiology. 15; 6:2333392819870774.

Garazi, M., Singer, C., Tai, J., & Ginocchio, C.C. (2012). Bloodstream infections caused by Stenotrophomonas maltophilia: a seven-year review. Journal of Hospital Infection. 81: 114-118.

Gibb, J., & Wong, D.W. (2021). Antimicrobial Treatment Strategies for Stenotrophomonas maltophilia: A Focus on Novel Therapies. Antibiotics (Basel). 9, 10(10):1226.

Horan, T.C., Andrus, M., & Dudeck, M.A. (2008). CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control. 36(5), 309-332.

Insuwanno, W., Kiratisin, P., & Jitmuang, A. (2020). Stenotrophomonas maltophilia Infections: Clinical Characteristics and Factors Associated with Mortality of Hospitalized Patients. Infection and Drug Resistance. 28(13), 1559-1566.

Jeon, Y.D., Jeong, W.Y., Kim, M.H., Jung, I.Y., Ahn, M.Y., Ann, H.W., … & Ku, N.S. (2016). Risk factors for mortality in patients with Stenotrophomonas maltophilia bacteremia. Medicine (Baltimore). 95(31), e4375.

Kim, E.J., Kim, Y.C., Ahn, J.Y., Jeong, S.J., Ku, N.S., Choi, J.Y., Yeom, J.S., & Song, Y.G. (2019). Risk factors for mortality in patients with Stenotrophomonas maltophilia bacteremia and clinical impact of quinolone-resistant strains. BMC Infectious Disease. 28;19(1):754.

Köseoğlu, O., Altun, B., Gülmez, D., Gür, D., & Sener, B. (2004). Stenotrophomonas maltophilia as a nosocomial pathogen. New Microbiologica. 27(3), 273-279.

Kwa, A.L., Low, J.G., Lim, T.P., Leow, P.C., Kurup, A., & Tam, V.H. (2008). Independent predictors for mortality in patients with positive Stenotrophomonas maltophilia cultures. Annals of the Academy of Medicine of Singapore. 37(10), 826-830.

Nicodemo, A.C., & Paez, J.I. (2007). Antimicrobial therapy for Stenotrophomonas maltophilia infections. European Journal of Clinical Microbiology & Infectious Disease. 26(4), 229-237.

Paez, J.I., & Costa, S.F. (2008). Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review. Journal of Hospital Infection. 70(2), 101-108.

Rhoads, & Daniel (2021). Stenotrophomonas maltophilia Susceptibility Testing Challenges and Strategies. Journal of clinical microbiology. 59. JCM0109421. 10.1128/JCM.01094-21.

Sader, H.S., Farrell, D.J., Flamm, R.K., & Jones, R.N. (2014). Antimicrobial susceptibility of Gram-negative organisms isolated from patients hospitalised with pneumonia in US and European hospitals: results from the SENTRY Antimicrobial Surveillance Program, 2009-2012. International Journal of Antimicrobial Agents. 43(4), 328-34.

Safdar, A., & Rolston, K.V. (2007). Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clinical Infectious Disease. 15;45(12), 1602-9.

Samonis, G., Karageorgopoulos, D.E., Maraki, S., Levis, P., Dimopoulou, D., Spernovasilis, N.A., Kofteridis, D.P., & alagas, M.E. (2012). Stenotrophomonas maltophilia infections in a general hospital: patient characteristics, antimicrobial susceptibility, and treatment outcome. The Public Library of Science One, 7(5), e37375.

Singhal, L., Kaur, P. & Gautam, V. (2017). Stenotrophomonas maltophilia: From trivial to grievous. Indian Journal of Medical Microbiology. 35(4):469-479.

Sumida, K., Chong, Y., Miyake, N., Akahoshi, T., Yasuda, M., Shimono, N., … & Akashi, K. (2015). Risk Factors Associated with Stenotrophomonas maltophilia Bacteremia: A Matched Case-Control Study. The Public Library of Science One. 24;10(7): e0133731.

Xun, M., Zhang, Y., Li, B.L., Wu, M., Zong, Y., & Yin, Y.M. (2014). Clinical characteristics and risk factors of infections caused by Stenotrophomonas maltophilia in a hospital in northwest China. Journal of Infection in Developing Countries. 13;8(8):1000-5.

Additional Files

Published

2023-05-15

How to Cite

Nitchot , W., & Arunyapongpaisan, B. (2023). Risk factors for mortality in patients with Stenotrophomonas maltophilia infection in Hatyai Hospital. Princess of Naradhiwas University Journal, 15(2), 84–96. Retrieved from https://li01.tci-thaijo.org/index.php/pnujr/article/view/257425

Issue

Section

Research Articles