title: Comparisons between patients with trimethoprim-sulfamethoxazole-susceptible and trimethoprim-sulfamethoxazole-resistant Stenotrophomonas maltophilia monomicrobial bacteremia: A 10-year retrospective study.
abstract: OBJECTIVE
  The impact of bacteremia due to the resistance of Stenotrophomonas maltophilia to trimethoprim-sulfamethoxazole (TMP-SXT) is uncertain. This study compared the clinical characteristics and outcomes of patients with TMP-SXT-susceptible (TSSSM) and TMP-SXT-resistant S. maltophilia (TSRSM) monomicrobial bacteremia.
  
  
  METHODS
  The medical records of adult patients with TSSSM and TSRSM monomicrobial bacteremia from January 2004 to December 2013 were reviewed and classified into two groups, namely, TSSSM and TSRSM.
  
  
  RESULTS
  There were 184 patients with monomicrobial S. maltophilia bacteremia. The mean age was 68.3 years. Most patients were males (72.8%), had high Charlson Comorbidity Index scores, previously prescribed antimicrobial agents, and indwelling medical devices. The 14-day and in-hospital mortality rates were 23.9% and 47.2%, respectively. There were 128 patients (69.6%) with TSSSM and 56 (30.4%) with TSRSM. The incidence of TSSSM bacteremia increased during the study period. The TSSSM and TSRSM groups had similar demographic and clinical characteristics and no significant differences in 14-day and in-hospital mortality (24.2% vs. 23.2%, p = 0.833; 50.0% vs. 41.1%, p = 0.264, respectively). Patients with TSSSM bacteremia had an increased risk of septic shock (p = 0.044) and neutropenia (p = 0.028) at bacteremia onset. Logistic regression analysis indicated that acquisition of TMP-SXT resistance was an independent risk factor for prolonged hospitalization (p = 0.018) and catheter-related S. maltophilia bacteremia was inversely associated with prolonged hospitalization after bacteremia (p = 0.032).
  
  
  CONCLUSIONS
  There were no significant differences in mortality for patients with TSSSM and TSRSM bacteremia, but patients with TSRSM bacteremia were associated with prolonged hospitalization after bacteremia onset.
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Ching-Hsun
authors.initials: CH
authors.lastname: Wang
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Jung-Chung
authors.initials: JC
authors.lastname: Lin
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Hsin-An
authors.initials: HA
authors.lastname: Lin
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Feng-Yee
authors.initials: FY
authors.lastname: Chang
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Ning-Chi
authors.initials: NC
authors.lastname: Wang
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Sheng-Kang
authors.initials: SK
authors.lastname: Chiu
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Te-Yu
authors.initials: TY
authors.lastname: Lin
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Ya-Sung
authors.initials: YS
authors.lastname: Yang
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Kan
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chin-Hsuan
authors.initials: CH
authors.lastname: Yang
authors.affiliation: Infection Control Office of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Chan
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: kmyeh@ndmctsgh.edu.tw.
authors.forename: Kuo-Ming
authors.initials: KM
authors.lastname: Yeh
mesh_terms: D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D020615:Stenotrophomonas maltophilia / Q000187:drug effects* / Q000276:immunology*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Stenotrophomonas maltophilia; bacteremia; resistance; trimethoprim–sulfamethoxazole