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Risk Factors Associated with Mortality in Nosocomial Stenotrophomonas maltophilia Pneumonia: A Single-Center
Yeşim Yıldız1, Özge Özgen Top1, Pınar Aysert Yıldız1
1Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Gazi University, Ankara, Turkey.
Background:
Stenotrophomonas maltophilia (S. maltophilia) is a multidrug-resistant pathogen frequently isolated in hospital-acquired pneumonia and represents a significant clinical challenge. This study aimed to investigate the risk factors associated with 30-day mortality in patients diagnosed with S. maltophilia pneumonia.
Methods:
This retrospective, single-center study included patients aged 18 years and older who were hospitalized between January 2018 and December 2021, had S. maltophilia isolated from respiratory samples, and demonstrated clinical and radiological evidence of pneumonia. Patients were grouped by 30-day survival status, and comparisons were made for demographic characteristics, risk factors, and antibiotic regimens.
Results:
Among the 200 evaluated patients, colonization was detected in 48%. A total of 104 patients met the inclusion criteria, of whom 75% required ICU admission. The 30-day mortality rate was 55.7%. Malignancies were present in 62.5%. Polymicrobial infections and coinfections were observed in 39.4% and 82.4%, respectively. Multivariate analysis identified SOFA (Sequential Organ Failure Assessment) score (OR = 1.293, 95% CI [1.113-1.501], p = 0.001), mechanical ventilation (OR = 5.005, 95% CI [1.379-18.157], p = 0.014), and a high Charlson Comorbidity Index (OR = 1.353, 95% CI [1.103-1.650], p = 0.004) as independent predictors of mortality. Combination antibiotic therapy had no significant effect on mortality. No resistance to trimethoprim-sulfamethoxazole was detected.
Conclusion:
S. maltophilia pneumonia is a serious nosocomial infection with high mortality, particularly in ICU patients with malignancies. SOFA score, mechanical ventilation, and a high Charlson Comorbidity Index were independently associated with increased mortality.
Insights
Stenotrophomonas maltophilia pneumonia has high mortality, especially in ICU patients. Sequential Organ Failure Assessment score, mechanical ventilation, and Charlson Comorbidity Index predict increased mortality risk.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pulmonology
Background:
- Stenotrophomonas maltophilia (S. maltophilia) is a multidrug-resistant pathogen causing hospital-acquired pneumonia.
- S. maltophilia pneumonia presents a significant clinical challenge due to its resistance patterns and associated mortality.
Purpose of the Study:
- To investigate risk factors for 30-day mortality in patients with S. maltophilia pneumonia.
- To identify independent predictors of mortality in this patient population.
Main Methods:
- Retrospective, single-center study of adult patients hospitalized between January 2018 and December 2021.
- Inclusion criteria: S. maltophilia isolated from respiratory samples with clinical and radiological pneumonia evidence.
- Patients were grouped by 30-day survival status for comparative analysis.
Main Results:
- The 30-day mortality rate was 55.7% among 104 eligible patients, with 75% requiring ICU admission.
- Independent predictors of mortality included Sequential Organ Failure Assessment (SOFA) score, mechanical ventilation, and a high Charlson Comorbidity Index.
- Combination antibiotic therapy did not significantly impact mortality; no trimethoprim-sulfamethoxazole resistance was observed.
Conclusions:
- S. maltophilia pneumonia is a severe nosocomial infection with a high mortality rate.
- Malignancies, high SOFA scores, mechanical ventilation, and elevated Charlson Comorbidity Index are associated with increased mortality.
- Further research may focus on targeted interventions for high-risk patients.
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