嗜麦芽窄养单胞菌菌血症的死亡率危险因素及其治疗意义

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-05-14 DOI:10.1016/j.jiph.2025.102829

Matthew Chung Yi Koh , Jinghao Nicholas Ngiam , Lionel Hon-Wai Lum , Nares Smitasin , Ka Lip Chew , David Michael Allen

{"title":"嗜麦芽窄养单胞菌菌血症的死亡率危险因素及其治疗意义","authors":"Matthew Chung Yi Koh , Jinghao Nicholas Ngiam , Lionel Hon-Wai Lum , Nares Smitasin , Ka Lip Chew , David Michael Allen","doi":"10.1016/j.jiph.2025.102829","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div><em>Stenotrophomonas maltophilia</em> is an important nosocomial pathogen. Bacteraemia is associated with significant morbidity, despite antibiotic therapy. Optimal treatment strategies for <em>Stenotrophomonas maltophilia</em> bacteraemia remain ill-defined. Thus, we retrospectively examined the clinical presentation, microbiological characteristics, treatment options to identify risk factors for mortality.</div></div><div><h3>Methods</h3><div>We performed a retrospective single-centre analysis of <em>Stenotrophomonas maltophilia</em> bacteraemia from 1 Jan 2012–30 Jun 2024. Data on the clinical presentation, source of infection, microbiological characteristics, treatment strategies and clinical outcomes were tabulated. Risk factors for in-hospital all-cause mortality were identified by appropriate univariate and multivariable analyses.</div></div><div><h3>Results</h3><div>There were 197 bacteraemia episodes. In-hospital mortality was 41.6 % (n = 82), and did not change significantly over the years. Patients who died were more likely to have prior carbapenem exposure (81.7 % vs 53.0 %, p < 0.001), presentation in an intensive care (ICU) setting (73.2 % vs 15.7 %, p < 0.001), and had a longer duration of fever (8.5 ± 2.5 vs 3.0 ± 3.8 days, p < 0.001). Microbiological isolation from additional sites other than the blood (e.g. sputum culture positivity) also correlated with mortality (39.0 % vs 7.8 %, p < 0.001). Over time, proportion of isolates resistant to fluoroquinolones increased. An initial antimicrobial choice containing trimethoprim-sulfamethoxazole appeared to be more likely to be associated with survival. Only 13 patients (6.6 %) received dual antibiotics initially, so it was unclear if this was associated with better outcomes. On multivariable analysis, ICU onset, elevated C-reactive protein, longer duration of fever and an absence of intervention for source control remained independently associated with mortality.</div></div><div><h3>Conclusions</h3><div>Source control of infection may be critical in improving survival in <em>Stenotrophomonas maltophilia</em> bacteraemia. Future prospective studies should validate important risk factors for mortality and define optimal antimicrobial treatment strategies.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 8","pages":"Article 102829"},"PeriodicalIF":4.7000,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk factors for mortality and implications on therapy for Stenotrophomonas maltophilia bacteraemia\",\"authors\":\"Matthew Chung Yi Koh , Jinghao Nicholas Ngiam , Lionel Hon-Wai Lum , Nares Smitasin , Ka Lip Chew , David Michael Allen\",\"doi\":\"10.1016/j.jiph.2025.102829\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div><em>Stenotrophomonas maltophilia</em> is an important nosocomial pathogen. Bacteraemia is associated with significant morbidity, despite antibiotic therapy. Optimal treatment strategies for <em>Stenotrophomonas maltophilia</em> bacteraemia remain ill-defined. Thus, we retrospectively examined the clinical presentation, microbiological characteristics, treatment options to identify risk factors for mortality.</div></div><div><h3>Methods</h3><div>We performed a retrospective single-centre analysis of <em>Stenotrophomonas maltophilia</em> bacteraemia from 1 Jan 2012–30 Jun 2024. Data on the clinical presentation, source of infection, microbiological characteristics, treatment strategies and clinical outcomes were tabulated. Risk factors for in-hospital all-cause mortality were identified by appropriate univariate and multivariable analyses.</div></div><div><h3>Results</h3><div>There were 197 bacteraemia episodes. In-hospital mortality was 41.6 % (n = 82), and did not change significantly over the years. Patients who died were more likely to have prior carbapenem exposure (81.7 % vs 53.0 %, p < 0.001), presentation in an intensive care (ICU) setting (73.2 % vs 15.7 %, p < 0.001), and had a longer duration of fever (8.5 ± 2.5 vs 3.0 ± 3.8 days, p < 0.001). Microbiological isolation from additional sites other than the blood (e.g. sputum culture positivity) also correlated with mortality (39.0 % vs 7.8 %, p < 0.001). Over time, proportion of isolates resistant to fluoroquinolones increased. An initial antimicrobial choice containing trimethoprim-sulfamethoxazole appeared to be more likely to be associated with survival. Only 13 patients (6.6 %) received dual antibiotics initially, so it was unclear if this was associated with better outcomes. On multivariable analysis, ICU onset, elevated C-reactive protein, longer duration of fever and an absence of intervention for source control remained independently associated with mortality.</div></div><div><h3>Conclusions</h3><div>Source control of infection may be critical in improving survival in <em>Stenotrophomonas maltophilia</em> bacteraemia. Future prospective studies should validate important risk factors for mortality and define optimal antimicrobial treatment strategies.</div></div>\",\"PeriodicalId\":16087,\"journal\":{\"name\":\"Journal of Infection and Public Health\",\"volume\":\"18 8\",\"pages\":\"Article 102829\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2025-05-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Infection and Public Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1876034125001789\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Public Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1876034125001789","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

摘要

背景嗜麦芽窄养单胞菌是一种重要的医院病原菌。尽管有抗生素治疗，菌血症仍与显著的发病率相关。嗜麦芽窄养单胞菌菌血症的最佳治疗策略仍不明确。因此，我们回顾性地检查了临床表现、微生物学特征、治疗方案，以确定死亡率的危险因素。方法对2012年1月1日至2024年 6月30日嗜麦芽窄养单胞菌菌血症进行回顾性单中心分析。将临床表现、感染源、微生物学特征、治疗策略和临床结果的数据制成表格。通过适当的单变量和多变量分析确定院内全因死亡率的危险因素。结果共发生菌血症197例。住院死亡率为41.6 % (n = 82)，多年来无显著变化。病人更有可能去世前碳青霉烯暴露(81.7 vs 53.0  % % p & lt; 0.001),表示在重症监护室(ICU) (73.2 vs 15.7  % % p & lt; 0.001),并长期发烧(8.5 ±2.5 vs 3.0  ± 3.8天,p & lt; 0.001)。除血液外其他部位的微生物分离（如痰培养阳性）也与死亡率相关（39.0 % vs 7.8 %,p <； 0.001）。随着时间的推移，对氟喹诺酮类药物耐药的分离株比例增加。最初选择含有甲氧苄啶-磺胺甲恶唑的抗菌药物似乎更有可能与生存有关。最初只有13名患者（6.6 %）接受了双重抗生素治疗，因此尚不清楚这是否与更好的结果相关。在多变量分析中，ICU发病、c反应蛋白升高、发热持续时间较长和缺乏源控制干预仍然与死亡率独立相关。结论控制感染源可能是提高嗜麦芽窄养单胞菌菌血症患者生存率的关键。未来的前瞻性研究应验证死亡率的重要危险因素，并确定最佳的抗菌治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Risk factors for mortality and implications on therapy for Stenotrophomonas maltophilia bacteraemia

Background

Stenotrophomonas maltophilia is an important nosocomial pathogen. Bacteraemia is associated with significant morbidity, despite antibiotic therapy. Optimal treatment strategies for Stenotrophomonas maltophilia bacteraemia remain ill-defined. Thus, we retrospectively examined the clinical presentation, microbiological characteristics, treatment options to identify risk factors for mortality.

Methods

We performed a retrospective single-centre analysis of Stenotrophomonas maltophilia bacteraemia from 1 Jan 2012–30 Jun 2024. Data on the clinical presentation, source of infection, microbiological characteristics, treatment strategies and clinical outcomes were tabulated. Risk factors for in-hospital all-cause mortality were identified by appropriate univariate and multivariable analyses.

Results

There were 197 bacteraemia episodes. In-hospital mortality was 41.6 % (n = 82), and did not change significantly over the years. Patients who died were more likely to have prior carbapenem exposure (81.7 % vs 53.0 %, p < 0.001), presentation in an intensive care (ICU) setting (73.2 % vs 15.7 %, p < 0.001), and had a longer duration of fever (8.5 ± 2.5 vs 3.0 ± 3.8 days, p < 0.001). Microbiological isolation from additional sites other than the blood (e.g. sputum culture positivity) also correlated with mortality (39.0 % vs 7.8 %, p < 0.001). Over time, proportion of isolates resistant to fluoroquinolones increased. An initial antimicrobial choice containing trimethoprim-sulfamethoxazole appeared to be more likely to be associated with survival. Only 13 patients (6.6 %) received dual antibiotics initially, so it was unclear if this was associated with better outcomes. On multivariable analysis, ICU onset, elevated C-reactive protein, longer duration of fever and an absence of intervention for source control remained independently associated with mortality.

Conclusions

Source control of infection may be critical in improving survival in Stenotrophomonas maltophilia bacteraemia. Future prospective studies should validate important risk factors for mortality and define optimal antimicrobial treatment strategies.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.