Stenotrophomonas maltophilia bloodstream infection in patients with hematologic malignancies: a retrospective study and in vitro activities of antimicrobial combinations
نویسندگان
چکیده
BACKGROUND Stenotrophomonas maltophilia causes serious infections in immunocompromised hosts. Here, we analyzed the clinical characteristics of S. maltophilia bloodstream infection (BSI) in patients with hematologic malignancies and evaluated in vitro synergistic effects of antimicrobial combinations. METHODS We retrospectively reviewed all consecutive episodes of S. maltophilia BSIs in adult hematologic patients from June 2009 to May 2014, with in vitro susceptibility and synergy tests using high-throughput bioluminescence assay performed for available clinical isolates. RESULTS Among 11,004 admissions during 5-year period, 31 cases were identified as S. maltophilia BSIs. The incidence rate of S. maltophilia BSI was 0.134 cases/1,000 patient-days. Overall and attributable mortality of S. maltophilia BSI was 64.5% and 38.7%, respectively. Severe neutropenia (adjusted hazard ratio [HR] 5.24, p =0.013), shock at the onset of BSI (adjusted HR 6.05, p <0.001), and pneumonia (adjusted HR 3.15, p =0.017) were independent risk factors for mortality. In vitro susceptibilities to ceftazidime, levofloxacin, ticarcillin-clavulanic acid (TIM) and trimethoprim-sulfamethoxazole (SXT) were 11.1%, 44.0%, 40.7%, and 88.9%, respectively. MIC50/MIC90 for moxifloxacin and tigecycline were 1/4 mg/L and 4/8 mg/L. The 50% and 90% fractional inhibitory concentrations (FIC(50)/FIC(90)) of clinical isolates against a combination of SXT and TIM were 0.500/0.750. For SXT plus levofloxacin or moxifloxacin, FIC(50)/FIC(90) were 0.625/1.000 and 0.625/0.625, respectively. CONCLUSION S. maltophilia BSIs show high mortality, which is related to severe neutropenia, shock, and S. maltophilia pneumonia. Based upon drug susceptibility testing, the primary treatment of choice for S. maltophilia BSIs should be SXT in hematologic patients, rather than quinolones, with combination therapies including SXT serving as a feasible treatment option.
منابع مشابه
Preemptive antifungal therapy among neutropenic patients.
lated from sputum samples obtained from 7 patients were not considered to represent systemic infection. Five (16%) of the patients with VRE bacteremia had polymicrobial infections with Stenotrophomonas maltophilia (2 patients), Escherichia coli (1), Pseudomonas aeruginosa (1), and Staphylococcus aureus (1). Most patients (71%) were neutropenic (absolute neutrophil count, !500 cells/mL) when the...
متن کاملFrequency of Pathogens and Antimicrobial Susceptibility of Bacteria Isolated from Bloodstream Infections
Background and Objectives: Blood stream infections cause significant morbidity and mortality in the world. In this study, we aimed at describing the organisms responsible for septicemia in 2006-2007 and their antimicrobial susceptibility that might lead to proper selection of antimicrobial agents in hospitalized patients with suspected sepsis. Materials and Methods: Microbiology reports of ...
متن کاملRetrospective analysis of Stenotrophomonas maltophilia bacteremia: clinical features, risk factors and therapeutic choices
Background: Stenotrophomonas maltophilia is an important nosocomial pathogen, which is of increasing frequency in blood stream infection, especially in immunocompromised patients. Objectives: Our study aims to investigate the demographics, clinical characteristics, risk factors, drug resistance and treatment choice of Stenotrophomonas maltophilia bacteremia, trying to find out the independent r...
متن کاملEmergence of Stenotrophomonas maltophilia nosocomial isolates in a Saudi children’s hospital
OBJECTIVES To describe the clinical characteristics of pediatric patients colonized or infected by Stenotrophomonas maltophilia (S. maltophilia) at a Saudi children's hospital, to identify risk factors associated with infection, and to investigate the antimicrobial resistance patterns of this emerging pathogen. Methods: In this cross-sectional observational study, 64 non-duplicating S. malto...
متن کاملAntimicrobial Resistance Pattern of Stenotrophomonas maltophilia Isolates from a Tertiary Care Setting in Rawalpindi, Pakistan
Introduction: Stenotrophomonas maltophilia is intrinsically resistant to many antimicrobials. Like Pseudomonas spp., this bacterium has a remarkable ability to cause infections, particularly in the respiratory and urinary tracts. This study aims to determine the antimicrobial resistance pattern of S. maltophilia isolates collected from a tertiary care setting and frequency of multi, extensively...
متن کامل