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Ventilator-associated pneumonia due to Stenotrophomonas maltophilia: Risk factors and outcome

Published:November 01, 2019DOI:https://doi.org/10.1016/j.jinf.2019.10.021

      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

      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)
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