Highlights
- •SM-VAP occurred lately after the onset of mechanichal ventilation.
- •Exposure to carbapenem and carboxy- or ureido-penicillin during the week before VAP and the severity of disease with respiratory and hematological failures were independent risk factors for the SM-VAP occurrence.
- •The prognosis of patients with SM-VAP was poor and not modified by the adequacy of antimicrobial therapy.
- •Antibiotics exposure the week before VAP and the severity of disease were independent risk factors for the SM-VAP occurrence.
Abstract
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.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
VAP (Ventilator–acquired pneumonia), ICU (intensive care unit), SM-VAP (Stenotrophomonas maltophilia ventilator–acquired pneumonia), Others-VAP (Others microorganisms ventilator–acquired pneumonia), Pyo-VAP (Pseudomonas aeruginosa ventilator–acquired pneumonia)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 01, 2019
Accepted:
October 26,
2019
Footnotes
The manuscript was written on behalf of the OUTCOMEREA study group listed in the appendix.
Identification
Copyright
© 2019 Published by Elsevier Ltd on behalf of The British Infection Association.
