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Nosocomial infection caused by Xanthomonas maltophilia: a case-control study of predisposing factors
L S Elting1, N Khardori, G P Bodey
1Department of Medical Specialties, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Abstract:
Factors predisposing to clinically significant nosocomial infection with Xanthomonas maltophilia were examined in a matched case-control study using multivariate techniques. Sixteen cases occurred among cancer patients in a six-month period, including an apparent cluster of three cases in an intensive care unit. These infections were unusually serious; eight patients had disseminated infection caused by X maltophilia and six died as a result of their infections. Among the 64 factors that were examined, therapy with broad-spectrum antibiotics and central venous catheterization were found to significantly increase susceptibility to infection. Therapy with imipenem was more than ten times more frequent among cases than among controls (p less than .001). All fatal infections occurred in patients who had received imipenem, including two patients who died before the organism could be identified and appropriate therapy instituted. Infection with X maltophilia should be suspected in patients who develop superinfection while receiving imipenem, and prompt therapy should be instituted to improve chances of survival. Because a common environmental source of X maltophilia was not identified, further study is necessary to determine specific preventive measures.
Insights
Broad-spectrum antibiotics and central venous catheters increase nosocomial infection risk from Xanthomonas maltophilia. Imipenem therapy was strongly associated with fatal infections, suggesting prompt treatment is crucial.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Medical Microbiology
Background:
- Nosocomial infections pose a significant threat in healthcare settings.
- Xanthomonas maltophilia is an opportunistic pathogen causing severe infections.
- Cancer patients are particularly vulnerable to healthcare-associated infections.
Purpose of the Study:
- To identify risk factors for nosocomial infection with Xanthomonas maltophilia.
- To investigate factors associated with severe outcomes and mortality.
- To inform preventive strategies and clinical management.
Main Methods:
- Matched case-control study design.
- Multivariate statistical analysis of 64 potential risk factors.
- Retrospective review of clinical data for cancer patients.
Main Results:
- Broad-spectrum antibiotics and central venous catheterization were significant risk factors.
- Imipenem use was strongly associated with infection (p < .001) and mortality.
- Eight cases of disseminated infection and six deaths were reported.
Conclusions:
- Xanthomonas maltophilia infection should be suspected in patients on imipenem with superinfections.
- Prompt diagnosis and appropriate therapy are critical for improving survival.
- Further research is needed to identify environmental sources and implement specific preventive measures.