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Ventilator-associated pneumonia due to Stenotrophomonas maltophilia: Risk factors and outcome
Wafa Ibn Saied1, Sybille Merceron2, Carole Schwebel3
1UMR 1137, IAME, Université Paris Diderot, Paris, France.
Background:
Stenotrophomonas maltophilia (SM) is increasingly identified in intensive care unit (ICU). This study aim to identify risk factors for SM ventilator-associated pneumonia (VAP) and whether it affects ICU mortality METHODS: Two nested matched case-control studies were performed based in OUTCOMEREA database. The first episodes of SM-VAP patients were matched with two different control groups: VAP due to other micro-organisms (VAP-other) and Pseudomonas aeruginosa VAP (Pyo-VAP). Matching criteria were the hospital, the SAPS II, and the previous duration of mechanical ventilation (MV).
Results:
Of the 102 SM-VAP patients (6.2% of all VAP patients), 92 were matched with 375 controls for the SM-VAP/other-VAP matching and 84 with 237 controls for the SM-VAP/Pyo-VAP matching. SM-VAP risk factors were an exposition to ureido/carboxypenicillin or carbapenem during the week before VAP, and respiratory and coagulation components of SOFA score upper to 2 before VAP. SM-VAP received early adequate therapy in 70 cases (68.6%). Risk factors for Day-30 were age (OR = 1.03; p < 0.01) and Chronic heart failure (OR = 3.15; p < 0.01). Adequate treatment, either monotherapy or combination of antimicrobials, did not modify mortality. There was no difference in 30-day mortality, but 60-day mortality was higher in patients with SM-VAP compared to Other-VAP (P = 0.056).
Conclusions:
In a large series, independent risk factors for the SM-VAP were ureido/carboxypenicillin or carbapenem exposure the week before VAP, and respiratory and coagulation components of the SOFA score > 2 before VAP. Mortality risk factors of SM-VAP were age and chronic heart failure. Adequate treatment did not improve SM-VAP prognosis.
Insights
Stenotrophomonas maltophilia ventilator-associated pneumonia (SM-VAP) is linked to prior antibiotic exposure and high SOFA scores. Risk factors for mortality include age and heart failure, with adequate treatment not improving prognosis.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Stenotrophomonas maltophilia (SM) is an emerging pathogen in intensive care units (ICUs).
- Ventilator-associated pneumonia (VAP) is a common ICU-acquired infection.
- Understanding SM-VAP is crucial for patient outcomes.
Purpose of the Study:
- Identify risk factors for SM-VAP.
- Determine the impact of SM-VAP on ICU mortality.
- Compare SM-VAP outcomes with other VAP etiologies.
Main Methods:
- Two nested matched case-control studies were conducted using the OUTCOMEREA database.
- SM-VAP cases were matched with controls (VAP-other and Pseudomonas aeruginosa VAP).
- Matching criteria included hospital, SAPS II score, and duration of mechanical ventilation.
Main Results:
- Independent risk factors for SM-VAP included prior exposure to ureido/carboxypenicillin or carbapenem and SOFA scores > 2 for respiratory and coagulation.
- Mortality risk factors for SM-VAP were advanced age and chronic heart failure.
- Adequate antimicrobial therapy did not significantly improve SM-VAP prognosis; 60-day mortality was higher compared to other VAP types.
Conclusions:
- Prior antibiotic exposure and elevated SOFA scores are key risk factors for SM-VAP.
- Age and chronic heart failure are significant predictors of mortality in SM-VAP patients.
- Current treatment strategies may not be sufficient to overcome the poor prognosis associated with SM-VAP.
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