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Independent predictors for mortality in patients with positive Stenotrophomonas maltophilia cultures
Andrea L H Kwa1, Jenny G H Low, Tze Peng Lim
1Department of Pharmacy, Singapore General Hospital, Singapore. andrea.kwa.l.h@sgh.com.sg
Introduction:
Stenotrophomonas maltophilia is an emerging pathogen in nosocomial infections that may result in high mortality. S. maltophilia often present as part of a polymicrobial culture and it is not well established when treatment is indicated. We aimed to identify predictors of mortality in patients with positive cultures of S. maltophilia.
Materials And Methods:
A retrospective cohort study in a tertiary care medical centre was performed in 150 adult patients with positive cultures of S. maltophilia. Patients' demographics, underlying diseases, severity of illness, length of hospitalisation, prior antibiotic exposure, number/types of indwelling catheters, culture sites, and appropriateness of empiric therapy were collected. Logistic regression was used to determine the independent risk factor(s) for infection-attributed mortality.
Results:
Ninety-nine males and 51 females were studied. The mean (SD) age and APACHE II score of the patients were 61.9 (16.0) and 14.0 (6.1), respectively. The respiratory tract was the most frequent site (55.3%) where S. maltophilia was isolated. Infection-attributed mortality was observed in 22 of the 150 patients (14.7 %). Admission to ICU [Odds ratio (OR), 3.767; 95% confidence interval (CI), 1.277-11.116, P = 0.016], and delayed effective treatment (OR, 18.684; 95% CI, 4.050-86.188; P <0.001) were identified as independent risk factors for mortality.
Conclusions:
Predictors of mortality in patients with positive cultures of S. maltophilia were identified, which may guide clinicians in patient assessment and devising therapeutic decisions. Further studies are needed to validate our results.
Insights
Predictors of mortality in Stenotrophomonas maltophilia infections include ICU admission and delayed treatment. Identifying these factors aids clinicians in patient assessment and treatment decisions for this emerging nosocomial pathogen.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Clinical Microbiology
Background:
- Stenotrophomonas maltophilia is an emerging pathogen causing nosocomial infections with high mortality.
- Optimal treatment timing for S. maltophilia, especially in polymicrobial cultures, remains unclear.
Purpose of the Study:
- To identify predictors of mortality in adult patients with positive S. maltophilia cultures.
- To guide clinical decision-making in managing S. maltophilia infections.
Main Methods:
- Retrospective cohort study of 150 adult patients with S. maltophilia.
- Data collected included demographics, comorbidities, illness severity (APACHE II), interventions, and treatment appropriateness.
- Logistic regression analysis identified independent risk factors for infection-attributed mortality.
Main Results:
- The respiratory tract was the most common isolation site (55.3%).
- Overall infection-attributed mortality was 14.7% (22/150 patients).
- Independent predictors of mortality were ICU admission (OR 3.767) and delayed effective treatment (OR 18.684).
Conclusions:
- Admission to the Intensive Care Unit (ICU) and delayed effective treatment are significant predictors of mortality in S. maltophilia infections.
- These findings can assist clinicians in risk stratification and therapeutic planning.
- Further research is recommended to validate these mortality predictors.