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A Controlled Mouse Model for Neonatal Polymicrobial Sepsis
Published on: January 27, 2019
Stenotrophomonas maltophilia Associated Factors and Outcomes in a Neonatal Intensive Care Unit: A Retrospective
Susannah Franco1,2, Ashraf Abdelhemid2, Lawrence Fordjour3
1From the Department of Pharmacy, University Hospital at Downstate, Brooklyn, New York.
Background:
Stenotrophomonas maltophilia is a multi-drug-resistant, hospital-acquired Gram-negative bacillus associated with significant morbidity and mortality. The objective of this study is to identify risk factors and outcomes associated with S. maltophilia isolation in a high-risk neonatal population.
Methods:
This was a retrospective matched case-control study. Cases were matched 1:2 for years of neonatal intensive care unit admission, completed weeks' gestational age and birth weight in 250-gram incremental categories.
Results:
A total of 15 cases and 35 controls were included in the analyses. Risk factors for S. maltophilia isolation included days of antibiotics (24 vs. 18, P = 0.036), days of broad-spectrum antibiotics (19 vs. 12 days, P = 0.027), days of meropenem (9 vs. 6 days, P = 0.018) and any meropenem exposure (100% vs. 22%, P = 0.005). Other risk factors were any corticosteroid exposure (66.7% vs. 20%, P = 0.001), days of total parenteral nutrition (55 vs. 31 days, P = 0.017) and days of invasive mechanical ventilation (28 vs. 7, P = 0.015). S. maltophilia isolation was associated with increased length of neonatal intensive care unit stay (134 vs. 69 days, P < 0.001) and mortality (33.3% vs. 0%, P = 0.001).
Conclusions:
Antibiotic stewardship efforts should be made to decrease the risk of S. maltophilia isolation and associated mortality. Carbapenem over-use should be specifically addressed with institutional policies and unit-based guidelines. Additional neonatal studies are needed to confirm these findings and explore other possible risk factors.
Insights
Stenotrophomonas maltophilia infections in neonates are linked to prolonged antibiotic use, corticosteroid exposure, and invasive procedures. This isolation significantly increases neonatal intensive care unit (NICU) stay and mortality, highlighting the need for antibiotic stewardship.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Critical Care
Background:
- Stenotrophomonas maltophilia is a multidrug-resistant bacterium frequently causing hospital-acquired infections.
- This pathogen is associated with considerable morbidity and mortality, particularly in vulnerable populations.
- Neonatal intensive care units (NICUs) are high-risk environments for such infections.
Purpose of the Study:
- To identify risk factors for Stenotrophomonas maltophilia isolation in a high-risk neonatal population.
- To determine the outcomes associated with S. maltophilia isolation in neonates.
Main Methods:
- A retrospective matched case-control study design was employed.
- Cases of S. maltophilia isolation were matched 1:2 with controls based on NICU admission year, gestational age, and birth weight.
- Data on antibiotic exposure, corticosteroid use, total parenteral nutrition, and mechanical ventilation were analyzed.
Main Results:
- Risk factors included extended duration of antibiotic and broad-spectrum antibiotic use, meropenem exposure, corticosteroid exposure, total parenteral nutrition, and invasive mechanical ventilation.
- S. maltophilia isolation was significantly associated with a longer NICU stay (134 vs. 69 days).
- Isolation of S. maltophilia was linked to increased mortality (33.3% vs. 0%).
Conclusions:
- Antibiotic stewardship is crucial to reduce S. maltophilia isolation and associated mortality in neonates.
- Overuse of carbapenems, such as meropenem, requires specific attention through institutional policies and guidelines.
- Further research in neonatal populations is necessary to validate these findings and explore additional risk factors.
