title: Risk Factors Associated with Stenotrophomonas maltophilia Bacteremia: A Matched Case-Control Study.
abstract: Stenotrophomonas maltophilia is an important nosocomial bacterial pathogen, as is Pseudomonas aeruginosa. Differentiation of these bacteria as bacteremic agents is critical in the clinical setting and to define a therapeutic strategy; however, the associated factors and prognosis for S. maltophilia bacteremia have not been fully evaluated to adequately characterize these factors. We first conducted a matched case-control study to clarify these questions. A total of 30 case patients with S. maltophilia bacteremia were compared with 30 control patients with P. aeruginosa bacteremia between January 2005 and August 2014, according to matching criteria based on underlying disease, age, and gender. The 30-day mortality rate for the case patients (53.3%) was significantly higher than that of the control group (30.0%) (P = 0.047, using the log-rank test). Conditional logistic regression analysis showed that the predisposing factors specific for the detection of S. maltophilia bacteremia were indwelling artificial products other than a central venous catheter, ICU stay, and previous use of anti-MRSA drugs. The high severity of illness was associated with mortality in both case and control patients. Interestingly, inappropriate antimicrobial treatment was an additional independent risk factor for mortality in only the case patients with S. maltophilia bacteremia (odds ratio = 13.64, P = 0.048). Monotherapy with fluoroquinolones inactive against the S. maltophilia isolates was mainly responsible for the inappropriate treatment. These results suggest that more precise prediction and more appropriate treatment might improve the prognosis of patients with S. maltophilia bacteremia.
authors.affiliation: Emergency and critical care center, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Sumida
authors.affiliation: Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
authors.forename: Yong
authors.initials: Y
authors.lastname: Chong
authors.affiliation: Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Miyake
authors.affiliation: Emergency and critical care center, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.affiliation: Emergency and critical care center, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yasuda
authors.affiliation: Center for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shimono
authors.affiliation: Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Shimoda
authors.affiliation: Emergency and critical care center, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
authors.affiliation: Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Akashi
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003428:Cross Infection; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D012307:Risk Factors; D020615:Stenotrophomonas maltophilia / Q000276:immunology