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Risk factors for mortality among patients with Stenotrophomonas maltophilia bacteremia in Tokyo, Japan, 1996-2009
1Department of Infectious Diseases, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan. h-araoka@toranomon.gr.jp
Abstract:
Stenotrophomonas maltophilia is an important nosocomial pathogen, especially among immunocompromised patients. The objective of this study was to clarify the clinical characteristics, prognosis, and prognostic factors of patients with S. maltophilia bacteremia in Japan. The microbiology records of all patients with S. maltophilia bacteremia between January 1996 and April 2009 at Toranomon Hospital, Tokyo, Japan, were retrospectively reviewed. A total of 53 cases of bacteremia were identified. Thirty patients had an underlying hematological disorder, and 23 were receiving hematopoietic transplantation. The overall mortality rate was 51%. On univariate analysis, neutropenia (p < 0.01), the presence of a central venous catheter, and mixed infection with enterococci (p < 0.05) were significantly related to the mortality. Among these variables, neutropenia (p < 0.01) and mixed infection with enterococci (p < 0.05) were independent factors associated with mortality. In contrast, all eight patients in whom S. maltophilia was the etiologic agent of catheter-related infection survived following catheter removal. S. maltophilia is an important pathogen among immunocompromised patients, especially in the neutropenic phase or mixed infection with enterococci. If a central venous catheter was present at the onset of S. maltophilia bacteremia, the prompt removal of the catheter was important.
Insights
Stenotrophomonas maltophilia bacteremia is a serious risk for immunocompromised patients, particularly those with neutropenia or mixed enterococcal infections. Prompt central venous catheter removal is crucial for survival.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Stenotrophomonas maltophilia is a significant nosocomial pathogen, posing a particular threat to immunocompromised individuals.
- Understanding the clinical spectrum and outcomes of S. maltophilia bacteremia is essential for effective patient management.
Purpose of the Study:
- To elucidate the clinical features, prognosis, and prognostic determinants in patients experiencing S. maltophilia bacteremia in Japan.
- To identify key factors influencing mortality in S. maltophilia bacteremia.
Main Methods:
- A retrospective review of microbiology records from January 1996 to April 2009 at Toranomon Hospital, Tokyo, Japan.
- Analysis of 53 cases of S. maltophilia bacteremia, focusing on patient demographics, underlying conditions, and treatment outcomes.
Main Results:
- The overall mortality rate for S. maltophilia bacteremia was 51%.
- Neutropenia and mixed infection with enterococci were identified as independent predictors of mortality.
- Patients with catheter-related infections caused by S. maltophilia survived after catheter removal.
Conclusions:
- S. maltophilia poses a significant threat to immunocompromised patients, especially during neutropenia or in cases of mixed infection with enterococci.
- The presence of a central venous catheter at the onset of S. maltophilia bacteremia necessitates prompt removal for improved patient outcomes.
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