Stenotrophomonas maltophilia endocarditis: a systematic review.
The disease characteristics, management, and outcome of Stenotrophomonas maltophilia endocarditis were evaluated by examining the reports on the subject identified through a comprehensive literature search. Twenty-three (17 male) cases of S.. maltophilia endocarditis were identified. Mean age was 41 +/- 15 years. All patients presented with fever. Prosthetic valves were involved in 12 (52%) cases. Among native valves, the aortic valve was most frequently involved (50%), followed by the tricuspid valve (36%). Twenty (87%) patients had underlying risk factors for the development of endocarditis, including prior valvular or congenital heart disease surgery (60%), intravenous drug abuse (32%), and infected intravascular lines (18%). The endocarditis was postoperative in 14 patients. Seventeen (74%) patients experienced complications including septic embolism (23%), cardiac abscesses (23%), and congestive heart failure (18%). A combination of two or more antibiotics was used in all cases except one. The frequently used antibiotics were aminoglycosides (59%), trimethoprim-sulfamethoxazole (48%), and penicillins (48%). One half of the patients required cardiac surgery, but the proportion of surgically treated cases was higher among prosthetic valve endocarditis (62%). Mortality was 39% and was equally distributed between patients with prosthetic and native valve endocarditis. The S. maltophilia endocarditis carries high complication and mortality rates. The antibiotic regimen should consist of a combination of multiple antibiotics guided by the sensitivity panel. Early surgery may be considered in patients not responding to antibiotic treatment and in those with prosthetic valve endocarditis.
Khan
Ijaz A
IA
Department of Medicine, Creighton University School of Medicine, Omaha, NE 68131, USA. ikhan@cardiac.creighton.edu
Mehta
Nirav J
NJ
D000328:Adult; D000368:Aged; D004697:Endocarditis, Bacterial / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000473:pathology / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification*