title: Stenotrophomonas maltophilia--the most worrisome threat among unusual non-fermentative gram-negative bacilli from hospitalized patients: a prospective multicenter study.
abstract: OBJECTIVE
  Isolation rates of unusual non-fermentative Gram-negative bacilli (i.e. other than Pseudomonas aeruginosa and Acinetobacter baumannii) are increasing but studies are limited to few observations. We aimed at determining risk factors for infection and influence of antibiotic treatment on the outcome.
  
  
  METHODS
  A six-month (December 1, 2008-May 31, 2009) prospective multicenter cohort study was conducted in nine French teaching hospitals. Characteristics of patients colonized or infected by unusual NF-GNB, adequacy of antimicrobial therapies, and outcome were analyzed.
  
  
  RESULTS
  Analysis of 158 patients (median age, 62.7 years) was conducted. Stenotrophomonas maltophilia was the predominant bacterial species isolated (39%) followed by Achromobacter group (15%) and non-baumannii Acinetobacter species (13%). Compared to colonized patients, infected ones were more frequently immunocompromised [relative risk (RR) = 1.63, (95% confidence interval (CI) = 1.02-2.60, P = 0.05)], hospitalized within the last three months [RR 1.67 (95% CI 1.09-2.58, P = 0.02)], admitted in an intensive care unit with central venous catheter [RR 1.74 (95% CI 1.15-2.63, P = 0.01)]. The overall hospital mortality concerned 28 patients (18%) but no association with inadequate antimicrobial treatment was found except in the group of S. maltophilia infected cases [RR 2.81 (95% CI 1.01-7.83, P = 0.02)].
  
  
  CONCLUSIONS
  Naturally carbapenems-resistant S. maltophilia is the main unusual NF-GNB pathogen in hospitalized patients, leading to inappropriate empirical antibiotic treatment at the time of emerging extended-spectrum β-lactamase-producing bacteria.
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Louis Mourier, Service de Microbiologie-Hygiène, 178 Rue des Renouillers, Colombes, France. vincent.fihman@lmr.aphp.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Fihman
authors.forename: Alban
authors.initials: A
authors.lastname: Le Monnier
authors.forename: Stephane
authors.initials: S
authors.lastname: Corvec
authors.forename: Francoise
authors.initials: F
authors.lastname: Jaureguy
authors.forename: Jacques
authors.initials: J
authors.lastname: Tankovic
authors.forename: Hervé
authors.initials: H
authors.lastname: Jacquier
authors.forename: Etienne
authors.initials: E
authors.lastname: Carbonnelle
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Bille
authors.forename: Marina
authors.initials: M
authors.lastname: Illiaquer
authors.forename: Vincent
authors.initials: V
authors.lastname: Cattoir
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D005285:Fermentation; D005602:France / Q000453:epidemiology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020615:Stenotrophomonas maltophilia / Q000187:drug effects / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems