Related Experiment Videos
[Infections caused by Stenotrophomonas maltophilia (SMA) in intensive care patients--a prospective case-control
M Raffenberg1, T Szymanski, A Lubasch
1Lungenklinik Heckeshorn, Zentralklinik Emil von Behring, Akademisches Lehrkrankenhaus der Freien Universität Berlin. haloheck@zedat.fu-berlin.de
Background And Objective:
The importance of Stenotrophomonas maltophilia (SMA) as an etiologic frequently polyresistant pathogen in severe nosocomial infections has increased.
Methods:
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.
Results:
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.
Conclusions:
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.
Insights
Stenotrophomonas maltophilia (SMA) infections in intensive care units (ICUs) are linked to severe chronic obstructive pulmonary disease (COPD), extended ICU stays, and carbapenem antibiotic use. These factors increase the risk of developing these difficult-to-treat nosocomial infections.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Critical Care Medicine
Context:
- Stenotrophomonas maltophilia (SMA) is an increasingly significant pathogen in severe nosocomial infections.
- Polyresistant strains of SMA pose a growing challenge in healthcare settings.
Purpose:
- To identify independent risk factors for nosocomial infections caused by Stenotrophomonas maltophilia (SMA).
- To analyze the association between patient characteristics, treatment, and SMA acquisition in an intensive care unit (ICU).
Summary:
- A prospective study in an ICU identified severe chronic obstructive pulmonary disease (COPD), prolonged length of stay, and prior carbapenem therapy as independent risk factors for SMA infections.
- Multivariate analysis revealed significant associations, with 15 potential risk factors initially identified.
- Four out of 16 patients with SMA infections died, highlighting the severity of these nosocomial infections.
Impact:
- Findings emphasize the need for targeted infection control strategies in ICUs, particularly for patients with COPD.
- Understanding these risk factors can guide antibiotic stewardship and reduce the incidence of SMA-related morbidity and mortality.
- The study contributes to the knowledge base for managing polyresistant bacterial infections in critical care settings.