title: Stenotrophomonas maltophilia infections in a general hospital: patient characteristics, antimicrobial susceptibility, and treatment outcome.
abstract: BACKGROUND
  Stenotrophomonas maltophilia is acquiring increasing importance as a nosocomial pathogen.
  
  
  METHODS
  We retrospectively studied the characteristics and outcome of patients with any type of S. maltophilia infection at the University Hospital of Heraklion, Crete, Greece, between 1/2005-12/2010. S. maltophilia antimicrobial susceptibility was tested with the agar dilution method. Prognostic factors for all-cause in-hospital mortality were assessed with multivariate logistic regression.
  
  
  RESULTS
  Sixty-eight patients (median age: 70.5 years; 64.7% males) with S. maltophilia infection, not related to cystic fibrosis, were included. The 68 patients were hospitalized in medical (29.4%), surgical (26.5%), hematology/oncology departments (23.5%), or the intensive care units (ICU; 20.6%). The most frequent infection types were respiratory tract (54.4%), bloodstream (16.2%), skin/soft tissue (10.3%), and intra-abdominal (8.8%) infection. The S. maltophilia-associated infection was polymicrobial in 33.8% of the cases. In vitro susceptibility was higher to colistin (91.2%), trimethoprim/sulfamethoxazole and netilmicin (85.3% each), and ciprofloxacin (82.4%). The empirical and the targeted treatment regimens were microbiologically appropriate for 47.3% and 63.6% of the 55 patients with data available, respectively. Most patients received targeted therapy with a combination of agents other than trimethoprim/sulfamethoxazole. The crude mortality and the mortality and the S. maltophilia infection-related mortality were 14.7% and 4.4%, respectively. ICU hospitalization was the only independent prognostic factor for mortality.
  
  
  CONCLUSIONS
  S. maltophilia infection in a general hospital can be associated with a good prognosis, except for the patients hospitalized in the ICU. Combination reigmens with fluoroquinolones, colistin, or tigecycline could be alternative treatment options to trimethoprim/sulfamethoxazole.
authors.affiliation: Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Samonis
authors.forename: Drosos E
authors.initials: DE
authors.lastname: Karageorgopoulos
authors.forename: Sofia
authors.initials: S
authors.lastname: Maraki
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Levis
authors.forename: Dimitra
authors.initials: D
authors.lastname: Dimopoulou
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Spernovasilis
authors.forename: Diamantis P
authors.initials: DP
authors.lastname: Kofteridis
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
mesh_terms: D000368:Aged; D002939:Ciprofloxacin; D003091:Colistin; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D006115:Greece / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D009428:Netilmicin; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020615:Stenotrophomonas maltophilia; D016896:Treatment Outcome; D014295:Trimethoprim
chemical_list: D009428:Netilmicin; D002939:Ciprofloxacin; D014295:Trimethoprim; D003091:Colistin