Lai Chung-Hsu, Chi Chih-Yu, Chen Hsin-Pai, Chen Te-Li, Lai Chorng-Jang, Fung Chang-Phone, Yu Kwok-Woon, Wong Wing-Wai, Liu Cheng-Yi
Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC.
J Microbiol Immunol Infect. 2004 Dec;37(6):350-8.
Stenotrophomonas maltophilia is an important nosocomial pathogen with intrinsic multi-drug resistance. This retrospective study reviewed 84 episodes of S. maltophilia bacteremia over a 4-year period from July 1999 to September 2003. Stenotrophomonas maltophilia bacteremia was hospital-acquired in 64 patients (76%), and developed after prolonged hospitalization in 48 (57%). Seventy patients (83%) had a central venous catheter (CVC), 64 (76%) had prior antibiotic therapy, 55 (65%) had underlying malignancy, and 43 (51%) were receiving immunosuppressive therapy. Twenty seven percent of the episodes of bacteremia had polymicrobial isolates. The overall and bacteremia-related mortality rates were 44% and 33%, respectively. Forty six percent of the bacteremia-related mortality occurred within 3 days after onset of symptoms. The most common sources of bacteremia were respiratory tract (33%) and CVC (31%), while the source of the bacteremia was unknown in 26% of episodes. The most effective antibiotics in vitro were trimethoprim-sulfamethoxazole, ciprofloxacin, chloramphenicol, and ceftazidime; however, a trend of increasing drug resistance in these agents was identified over the study period. On univariate analysis, nosocomial bacteremia, long-lasting neutropnenia (>10 days), bacteremia originating from the respiratory tract, shock, low serum albumin level (<3 g/dL), and thrombocytopenia (platelet count <100,000/mm3) were significantly related to mortality (p<0.05). Among these variables, shock and thrombocytopenia were independent factors associated with mortality. In contrast, patients with CVC-related bacteremia had a lower mortality rate (odds ratio, 0.04; p<0.001). Patients treated with appropriate antibiotics had a lower mortality rate, but this difference was not significant (p=0.477). In S. maltophilia bacteremia, careful evaluation of CVC was important for identifying the source of bacteremia and predicting prognosis. The source of bacteremia and condition of patients at presentation were the major factors influencing prognosis.
嗜麦芽窄食单胞菌是一种具有固有多重耐药性的重要医院病原体。这项回顾性研究回顾了1999年7月至2003年9月这4年期间84例嗜麦芽窄食单胞菌菌血症病例。64例（76%）患者的嗜麦芽窄食单胞菌菌血症为医院获得性，48例（57%）在长期住院后发生。70例（83%）患者有中心静脉导管（CVC），64例（76%）曾接受过抗生素治疗，55例（65%）有潜在恶性肿瘤，43例（51%）正在接受免疫抑制治疗。27%的菌血症病例有多种微生物分离株。总体死亡率和菌血症相关死亡率分别为44%和33%。46%的菌血症相关死亡发生在症状出现后3天内。菌血症最常见的来源是呼吸道（33%）和CVC（31%），而26%的病例菌血症来源不明。体外最有效的抗生素是复方新诺明、环丙沙星、氯霉素和头孢他啶；然而，在研究期间发现这些药物的耐药性有增加趋势。单因素分析显示，医院获得性菌血症、长期中性粒细胞减少（>10天）、呼吸道源性菌血症、休克、低血清白蛋白水平（<3 g/dL）和血小板减少（血小板计数<100,000/mm3）与死亡率显著相关（p<0.05）。在这些变量中，休克和血小板减少是与死亡率相关的独立因素。相比之下，CVC相关菌血症患者的死亡率较低（优势比，0.04；p<0.001）。接受适当抗生素治疗的患者死亡率较低，但差异不显著（p=0.477）。在嗜麦芽窄食单胞菌菌血症中，仔细评估CVC对于确定菌血症来源和预测预后很重要。菌血症来源和患者就诊时的状况是影响预后的主要因素。
