全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

Stenotrophomonas maltophilia Bacteraemia: Analysis of 33 Episodes Occurred in the ICU at the University Hospital in Sousse, Tunisia

DOI: 10.4236/oalib.1100954, PP. 1-12

Subject Areas: Epidemiology, Infectious Diseases

Keywords: Stenotrophomonas Maltophilia, Bacteraemia, ICU, Risk Factors, Mortality

Full-Text   Cite this paper   Add to My Lib

Abstract

Background: Stenotrophomonas maltophilia is a multidrug-resistant, Gram negative bacillus that has emerged as an opportunistic pathogen associated with high morbidity and mortality rates. Aim: The aim of this study is to describe the characteristics of patients with bloodstream infections due to S. maltophilia. Methods: A descriptive retrospective study was performed at the ICUs over seven-year period in a teaching hospital. Cases of SMB were identified through a review of clinical microbiology laboratory and patient’s records were retrieved for analysis. Findings: There were 22 deaths (71%) 15 ± 12 days after the bactaeremia. In our study, more than half of patients (17/31) was exposed to broad-spectrum antibiotic specifically imipinem (IMP) before their positive culture. Antibiotic susceptibility testing revealed that isolates were most sensitive to ciprofloxacin (84%) and to trimethoprim-sulfamethoxazole (71%). A probable portal of entry was identified in 27.3% of cases and 57% were catheter-related. Conclusion: Our results were similar to those described by other authors reported in the literature in the last 20 years. Prevention of S. maltophilia acquisition and infection depends on higher emphasis on control of antimicrobial consumption and consideration of environmental reservoirs.

Cite this paper

Jaidane, N. , Chaouech, C. , Naija, W. , Boujaafar, N. and Bouallegue, O. (2014). Stenotrophomonas maltophilia Bacteraemia: Analysis of 33 Episodes Occurred in the ICU at the University Hospital in Sousse, Tunisia. Open Access Library Journal, 1, e954. doi: http://dx.doi.org/10.4236/oalib.1100954.

References

[1]  Lai, C.H., Chi, C.Y., Chen, H.P., et al. (2004) Clinical Characteristics and Prognostic Factors of Patients with Stenotrophomonas maltophilia Bacteremia. Journal of Microbiology, Immunology and Infection, 37, 350-358.
[2]  Senol, E., DesJardin, J., Stark, P.C., Barefoot, L. and Snydman, D.R. (2002) Attributable Mortality of Stenotrophomonas maltophilia Bacteremia. Clinical Infectious Diseases, 34, 1653-1656. 
http://dx.doi.org/10.1086/340707
[3]  Looney, W.J., Narita, M. and Mühlemann, K. (2009) Stenotrophomonas maltophilia: An Emerging Opportunist Human Pathogen. The Lancet Infectious Diseases, 9, 312-323. 
http://dx.doi.org/10.1016/S1473-3099(09)70083-0
[4]  Morrison, A.J., Hoffmann, K.K. and Wenzel, R.P. (1986) Associated Mortality and Clinical Characteristics of Nosocomial Pseudomonas maltophilia in a University Hospital. Journal of Clinical Microbiology, 24, 52-55.
[5]  Friedman, N.D., Korman, T.M., Fairley, C.K., Franklin, J.C. and Spelman, D.W. (2002) Bacteremia Due to Stenotrophomonas maltophilia: An Analysis of 45 Episodes. Journal of Infection, 45, 47-53. 
http://dx.doi.org/10.1053/jinf.2002.0978
[6]  Apisarnthanarak, A., Mayfield, J.L., Garison, T., et al. (2003) Risk Factors for Stenotrophomonas maltophilia Bacteremia in Oncology Patients: A Case-Control Study. Infection Control and Hospital Epidemiology, 24, 269-274. 
http://dx.doi.org/10.1086/502197
[7]  Schaumann, R., Stein, K., Eckhardt, C., Ackermann, G. and Rodloff, A.C. (2001) Infections Caused by Stenotrophomonas maltophilia—A Prospective Study. Infection, 29, 205-208. 
http://dx.doi.org/10.1007/s15010-001-1055-4
[8]  Hanes, S.D., Demirkan, K., Tolley, E., et al. (2002) Risk Factors for Late-Onset Nosocomial Pneumonia Caused by Stenotrophomonas maltophilia in Critically Ill Trauma Patients. Clinical Infectious Diseases, 35, 228-235. 
http://dx.doi.org/10.1086/341022
[9]  Khan, I.A. and Mehta, N.J. (2002) Stenotrophomonas maltophilia Endocarditis: A Systematic Review. Angiology, 53, 49-55.
[10]  Tunger, O., Vural, S., Cetin, C.B., Keles, G., Borand, H. and Gazi, H. (2007) Clinical Aspects and Risk Factors of Nosocomial Stenotrophomonas maltophilia Bacteremia Episodes in a Turkish Intensive Care Unit. Journal of Chemotherapy, 19, 658-664. 
http://dx.doi.org/10.1179/joc.2007.19.6.658
[11]  Muder, R.R., Harris, A.P., Muller, S., Edmond, M., Chow, J.W., Papadakis, K., et al. (1996) Bacteremia Due to Stenotrophomonas (Xanthomonas) Maltophilia: A Prospective, Multicenter Study of 91 Episodes. Clinical Infectious Diseases, 22, 508-512. 
http://dx.doi.org/10.1093/clinids/22.3.508
[12]  Elting, L.S. and Bodey, G.P. (1990) Septicemia Due to Xanthomonas Species and Non-Aeruginosa Pseudomonas Species: Increasing Incidence of Catheter-Related Infections. Medicine, 69, 296-306.
http://dx.doi.org/10.1097/00005792-199009000-00003
[13]  Paez, J.I.G. and Costa, S.F. (2008) Risk Factors Associated with Mortality of Infections Caused by Stenotrophomonas maltophilia: A Systematic Review. Journal of Hospital Infection, 70, 101-108. 
http://dx.doi.org/10.1016/j.jhin.2008.05.020
[14]  Del Toro, M.D., Rodríguez-Bano, J., Herrero, M., Herrero, M., Rivero, A., García-Ordonez, M.A., et al. (2002) Clinical Epidemiology of Stenotrophomonas maltophilia Colonization and Infection: A Multicenter Study. Medicine, 81, 228-239. 
http://dx.doi.org/10.1097/00005792-200205000-00006
[15]  Carmeli, Y. and Samore, M.H. (1997) Comparison of Treatment with Imipenem vs. Ceftazidime as a Predisposing Factor for Nosocomial Acquisition of Stenotrophomonas maltophilia: A Historical Cohort Study. Clinical Infectious Diseases, 24, 1131-1134. 
http://dx.doi.org/10.1086/513652
[16]  Denton, M. and Kerr, K.G. (1998) Microbiological and Clinical Aspects of Infection Associated with Stenotrophomonas maltophilia. Clinical Microbiology Reviews, 11, 57-80.
[17]  Khardori, N., Elting, L., Wong, E., Schable, B. and Bodey, G.P. (1990) Nosocomial Infections Due to Xanthomonas maltophilia (Pseudomonas maltophilia) in Patients with Cancer. Clinical Infectious Diseases, 12, 997-1003.
http://dx.doi.org/10.1093/clinids/12.6.997
[18]  Araoka, H., Baba, M. and Yoneyama, A. (2010) Risk Factors for Mortality among Patients with Stenotrophomonas maltophilia Bacteremia in Tokyo, Japan, 1996-2009. European Journal of Clinical Microbiology & Infectious Diseases, 29, 605-608. 
http://dx.doi.org/10.1007/s10096-010-0882-6
[19]  Platsouka, E., Routsi, C., Chalkis, A., Dimitriadou, E., Paniara, O. and Roussos, C. (2002) Stenotrophomonas maltophilia Meningitis, Bacteremia and Respiratory Infection. European Journal of Clinical Microbiology & Infectious Diseases, 34, 391-392. 
http://dx.doi.org/10.1080/00365540110080520
[20]  Crum, N.F., Utz, G.C. and Wallace, M.R. (2002) Stenotrophomonas maltophilia Endocarditis. Scandinavian Journal of Infectious Diseases, 34, 925-927.
[21]  Comité de L’Antibiogramme Société Francaise de Microbiologie (CASFM). Editions de 2002 à 2011.
[22]  Micozzi, A., Venditti, M., Monaco, M., Friedrich, A., Taglietti, F., Santilli, S., et al. (2000) Bacteremia Due to Stenotrophomonas maltophilia in Patients with Hematologic Malignancies. Clinical Infectious Diseases, 31, 705-711. 
http://dx.doi.org/10.1086/314043
[23]  Victor, M.A., Arpi, M., Bruun, B., Jonsson, V. and Hansen, M.M. (1994) Xanthomonas maltophilia Bacteremia in Immunocompromised Hematological Patients. Scandinavian Journal of Infectious Diseases, 26, 163-170. 
http://dx.doi.org/10.3109/00365549409011780
[24]  Elting, L.S., Khardori, N., Bodey, G.P. and Fainstein, V. (1990) Nosocomial Infection Caused by Xanthomonas maltophilia: A Case-Control Study of Predisposing Factors. Infection Control and Hospital Epidemiology, 11, 134-138.
http://dx.doi.org/10.2307/30145475
[25]  Wang, W.S., Liu, C.P., Lee, C.M. and Huan, F.Y. (2004) Stenotrophomonas maltophilia Bacteremia in Adults: Four Years Experience in a Medical Center in Northern Taiwan. Journal of Microbiology, Immunology and Infection, 37, 359-365.
[26]  Cheong, H.S., Lee, J.A., Kang, C.I., Chung, D.R., Peck, K.R., Kim, E.S., et al. (2008) Risk Factors for Mortality and Clinical Implications of Catheterrelated Infections in Patients with Bacteraemia Caused by Stenotrophomonas maltoph- ilia. International Journal of Antimicrobial Agents, 32, 538-547. 
http://dx.doi.org/10.1016/j.ijantimicag.2008.05.011
[27]  Nseir, S., Di Pompeo, C., Brisson, H., Dewavrin, F., Tissier, S., Diarra, M., et al. (2006) Intensive Care Unit-Acquired Stenotrophomonas maltophilia: Incidence, Risk Factors, and Outcome. Critical Care, 10, R143. 
http://dx.doi.org/10.1186/cc5063
[28]  Metan, G. and Uzun, O. (2005) Impact of Initial Antimicrobial Therapy in Patients with Bloodstream Infections Caused by Stenotrophomonas maltophilia. Antimicrobial Agents and Chemotherapy, 49, 3980-3981.
http://dx.doi.org/10.1128/AAC.49.9.3980-3981.2005
[29]  Ubeda, P., Salavert M., Giner, S., Jarque, I., López-Aldeguer, J., Pérez-Bellés, C. and Gobernado, M. (1998) Bacteremia Caused by Stenotrophomonas maltophilia: A Clinical-Epidemiological Study and Resistance Profile. Revista espanola de quimioterapia, 11, 205-215.
[30]  Villarino, M.E., Stevens, L.E., Schable, B., Mayers, G., Miller, J.M., Burke, J.P., et al. (1992) Risk Factors for Epide- mic Xanthomonas maltophilia Infection/Colonization in Intensive Care Unit Patients. Infection Control and Hospital Epidemiology, 13, 201-206. 
http://dx.doi.org/10.2307/30147098
[31]  Ansari, S.R., Hanna, H., Hachem, R., Jiang, Y., Rolston, K. and Raad, I. (2007) Risk Factors for Infections with Multidrug-Resistant Stenotrophomonas maltophilia in Patients with Cancer. Cancer, 109, 2615-2622.
http://dx.doi.org/10.1002/cncr.22705
[32]  Gopalakrishnan, R., Hawley, H.B., Czachor, J.S., Markert, R.J. and Bernstein, J.M. (1999) Stenotrophomonas maltophilia Infection and Colonization in the Intensive Care Units of Two Community Hospitals. A Study of 143 Patients. Heart & Lung: The Journal of Acute and Critical Care, 28, 134-141. 
http://dx.doi.org/10.1053/hl.1999.v28.a96418
[33]  Boktour, M., Hanna, H., Ansari, S., Bahna, B., Hachem, R., Tarrand, J., Rolston, K., Safdar, A. and Raad, I. (2006) Central Venous Catheter and Stenotrophomonas maltophilia Bacteremia in Cancer Patients. Cancer, 106, 1967-1973.
http://dx.doi.org/10.1002/cncr.21846
[34]  Tsai, W.P., Chen, C.L., Ko, W.C. and Pan, S.C. (2006) Stenotrophomonas maltophilia Bacteremia in Burn Patients. Burns, 32, 155-158. 
http://dx.doi.org/10.1016/j.burns.2005.08.016
[35]  Jang, T.N., Wang, F.D., Wang, L.S., Liu, C.Y. and Liu, I.M. (1992) Xanthomonas maltophilia Bacteremia: An Analysis of 32 Cases. Journal of the Formosan Medical Association, 91, 1170-1176.
[36]  Noskin, G.A. and Grohmann, S.M. (1992) Xanthomonas maltophilia Bacteremia: An Analysis of Factors Influencing Outcome. Infectious Diseases in Clinical Practice, 1, 230-236. 
http://dx.doi.org/10.1097/00019048-199207000-00003
[37]  Paez, J.I., Tengan, F.M., Barone, A.A., Levin, A.S. and Costa, S.F. (2008) Factors Associated with Mortality in Patients with Bloodstream Infection and Pneumonia Due to Stenotrophomonas maltophilia. European Journal of Clinical Microbiology & Infectious Diseases, 27, 901-906. 
http://dx.doi.org/10.1007/s10096-008-0518-2
[38]  Lai, C.H., Wong, W.W., Chin, C., Huang, C.K., Lin, H.H., Chen, W.F., et al. (2006) Central Venous Catheter-Related Stenotrophomonas maltophilia Bacteraemia and Associated Relapsing Bacteraemia in Haematology and Oncology Patients. Clinical Microbiology and Infection, 12, 986-991. 
http://dx.doi.org/10.1111/j.1469-0691.2006.01511.x
[39]  Rodloff, A.C., Goldstein, E.J.C. and Torres, A. (2006) Two Decades of Imipenem Therapy. Journal of Antimicrobial Chemotherapy, 58, 916-929. 
http://dx.doi.org/10.1093/jac/dkl354
[40]  Meyer, E., Schwab, F., Gastmeier, P., Rueden, H., Daschner, F.D. and Jonas, D. (2006) Stenotrophomonas maltophilia and Antibiotic Use in German Intensive Care Units: Data from Project SARI (Sur-veillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units. Journal of Hospital Infection, 64, 238-243.
http://dx.doi.org/10.1016/j.jhin.2006.07.006
[41]  Raffenberg, M., Szymanski, T., Lubasch, A., Erbes, R., Wagner, S., Weist, K., et al. (2001) Infections Caused by Stenotrophomonas maltophilia (SMA) in Intensive Care Patients: A Prospective Case-Control Study. Dtsch Med Wochenschr, 126, 514-518. 
http://dx.doi.org/10.1055/s-2001-13294
[42]  Vartivarian, S.E., Papadakis, K.A. and Anaissie, E.J. (1996) Stenotrophomonas (Xanthomonas) Maltophilia Urinary Tract Infection. A Disease That Is Usually Severe and Complicated. Archives of Internal Medicine, 156, 433-435.
http://dx.doi.org/10.1001/archinte.1996.00440040111012
[43]  Betriu, C., Sánchez, A., Palau, M.L., Gómez, M. and Picazo, J.J. (2001) Antibiotic Resistance Surveillance of Steno- trophomonas maltophilia, 1993-1999. Journal of Antimicrobial Chemotherapy, 48, 152-154. 
http://dx.doi.org/10.1093/jac/48.1.152
[44]  Safdar, A. and Rolston, K.V. (2007) Stenotrophomonas maltophilia: Changing Spectrum of a Serious Bacterial Pathogen in Patients with Cancer. Clinical Infectious Diseases, 45, 1602-1609. 
http://dx.doi.org/10.1086/522998
[45]  Wu, P.S., Lu, C.Y., Chang, L.Y., Hsueh, P.R., Lee, P.I., Chen, J.M., et al. (2006) Stenotrophomonas maltophilia Bacteremia in Pediatric Patients—A 10-Year Analysis. Journal of Microbiology, Immunology and Infection, 39, 144-149.
[46]  Zelenitsky, S.A., Iacovides, H., Ariano, R.E. and Harding, G.K.M. (2005) Antibiotic Combinations Significantly More Active than Monotherapy in an in Vitro Infection Model of Stenotrophomonas maltophilia. Diagnostic Microbiology and Infectious Disease, 51, 39-43. 
http://dx.doi.org/10.1016/j.diagmicrobio.2004.09.002
[47]  Falagas, M.E., Valkimadi, P.E., Huang, Y.T., Matthaiou, D.K. and Hsueh, P.R. (2008) Therapeutic Options for Stenotrophomonas maltophilia Infections Beyond Co-Trimoxazole: A Systematic Review. Journal of Antimicrobial Chemotherapy, 62, 889-894. 
http://dx.doi.org/10.1093/jac/dkn301
[48]  Valdezate, S., Vindel, A., Loza, E., Baquero, F. and Cantón, R. (2001) Antimicrobial Susceptibilities of Unique Stenotrophomonas maltophilia Clinical Strains. Antimicrobial Agents and Chemotherapy, 45, 1581-1584.
http://dx.doi.org/10.1128/AAC.45.5.1581-1584.2001
[49]  Gales, A.C., Jones, R.N., Forward, K.R., Linares, J., Sader, H.S. and Verhoef, J. (2001) Emerging Importance of Multi-Drug Resistant Acinetobacter Species and Stenotrophomonas maltophilia as Pathogens in Severely Ill Patients: Geographic Patterns, Epidemiological Features and Trends in the SENTRY Antimicrobial Surveillance Program (1997-1999). Clinical Infectious Diseases, 32, 104-113. 
http://dx.doi.org/10.1086/320183
[50]  Nicodemo, A.C. and Paez, J.I.G. (2007) Antimicrobial Therapy for Stenotrophomonas maltophilia Infections. European Journal of Clinical Microbiology & Infectious Diseases, 26, 229-237. 
http://dx.doi.org/10.1007/s10096-007-0279-3
[51]  Tsiodras, S., Pittet, D., Carmeli, Y., Eliopoulos, G., Boucher, H. and Harbath, S. (2000) Clinical Implications of Stenotrophomonas maltophilia Resistant to Trimethoprim-Sulfamethoxazole: A Study of 69 Patients at 2 University Hos- pitals. Scandinavian Journal of Infectious Diseases, 32, 651-656. 
http://dx.doi.org/10.1080/003655400459577
[52]  Gabriel, P.S., Zhou, J., Tabibi, S., Chen, Y., Trauzzi, M. and Saiman, L. (2004) Antimicrobial Susceptibility and Synergy Studies of Stenotrophomonas maltophilia Isolates from Patients with Cystic Fibrosis. Antimicrobial Agents and Chemotherapy, 28, 168-171. 
http://dx.doi.org/10.1128/AAC.48.1.168-171.2004
[53]  Betriu, C., Rodríguez-Avial, I., Sánchez, B.A., Gómez, M. and Picazo, J.J. (2002) Comparative in Vitro Activities of Tigecycline (GAR-936) and Other Antimicrobial Agents against Stenotrophomonas maltophilia. Journal of Antimicrobial Chemotherapy, 50, 758-759. 
http://dx.doi.org/10.1093/jac/dkf196
[54]  Betriu, C., Rodriguez-Avial, I., Sánchez, B.A., Gómez, M., Alvarez, J. and Picazo, J.J. (2002) In Vitro Activities of Tigecycline (GAR-936) against Recently Isolated Clinical Bacteria in Spain. Antimicrobial Agents and Chemotherapy, 46, 892-895. 
http://dx.doi.org/10.1128/AAC.46.3.892-895.2002
[55]  Bonfiglio, G., Cascone, C., Azzarelli, C., Cafiso, V., Marchetti, F. and Stefani, S. (2000) Levofloxacin in Vitro Activity and Time-Kill Evaluation of Stenotrophomonas maltophilia Clinical Isolates. Journal of Antimicrobial Chemotherapy, 45, 115-117. 
http://dx.doi.org/10.1093/jac/45.1.115
[56]  Al-Jasser, A.M. (2006) Stenotrophomonas maltophilia Resistant to Trime-thoprim-Sulfamethoxazole: An Increasing Problem. Annals of Clinical Microbiology and Antimicrobials, 5, 23. 
http://dx.doi.org/10.1186/1476-0711-5-23
[57]  Brooke, J.S. (2012) Stenotrophomonas maltophilia: An Emerging Global Opportunistic Pathogen. Clinical Microbiology Reviews, 25, 1-41. 
http://dx.doi.org/10.1128/CMR.00019-11
[58]  Liaw, S.J., Teng, L.J., Hsueh, P.R., Ho, S.W. and Luh, K.T. (2002) In Vitro Activities of Antimicrobial Combinations against Clinical Isolates of Stenotrophomonas maltophilia. Journal of the Formosan Medical Association, 101, 495- 501.
[59]  Yeshurun, M., Gafter-Gvili, A., Thaler, M., Keller, N., Nagler, A. and Shimoni, A. (2010) Clinical Characteristics of Stenotrophomonas maltophilia Infection in Hematopoietic Stem Cell Transplantation Recipients: A Single Center Experience. Infection, 38, 211-215. 
http://dx.doi.org/10.1007/s15010-010-0023-2

Full-Text


comments powered by Disqus

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133

WeChat 1538708413