Paez J I Garcia, Tengan F M, Barone A A, Levin A S, Costa S F
Department of Infectious Diseases, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil.
Eur J Clin Microbiol Infect Dis. 2008 Oct;27(10):901-6. doi: 10.1007/s10096-008-0518-2. Epub 2008 May 16.
Severe infections caused by Stenotrophomonas maltophilia are associated with high mortality, and strategies to improve the clinical outcome for infected patients are needed. A retrospective cohort study of patients with bloodstream infection (BSIs) and pneumonia caused by S. maltophilia was conducted. Multivariate analysis was performed to access factors associated with 14-day mortality. A total of 60 infections were identified. Among these, eight (13%) were pneumonias and 52 were BSIs; 33.3% were primary, 13% were central venous catheter (CVC)-related and 40% were secondary BSIs. Fifty-seven (85%) patients had received previous antimicrobial therapy; 88% had CVC, 57% mechanical ventilation and 75% were in the intensive care unit at the onset of infection. Malignancy (45%) was the most frequent underlying disease. The mean of the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores was 17 and for the Sepsis-related Organ Failure Assessment (SOFA) score, it was 7 points. The overall and 14-day mortality were, respectively, 75% and 48%. Forty-seven (78%) patients were treated and, of these, 74% received trimethoprim-sulfamethoxazole. Independent risk factors associated with mortality were SOFA index >6 points (0.005) and septic shock (0.03). The Kaplan-Meier estimations curves showed that patients with APACHE II score >20 and SOFA score >10 had a survival chance of, respectively, less than 8% and less than 10% (P<or=0.001) at 21 days after the first positive S. maltophilia culture. Our results suggest that the independent factors associated with outcome in patients with infection caused by S. maltophilia are septic shock and higher SOFA index.
嗜麦芽窄食单胞菌引起的严重感染与高死亡率相关，因此需要采取策略来改善感染患者的临床结局。我们对嗜麦芽窄食单胞菌引起的血流感染（BSIs）和肺炎患者进行了一项回顾性队列研究。进行多变量分析以确定与14天死亡率相关的因素。共识别出60例感染病例。其中，8例（13%）为肺炎，52例为BSIs；33.3%为原发性，13%与中心静脉导管（CVC）相关，40%为继发性BSIs。57例（85%）患者此前接受过抗菌治疗；88%患者有CVC，57%患者接受机械通气，75%患者在感染发作时入住重症监护病房。恶性肿瘤（45%）是最常见的基础疾病。急性生理与慢性健康状况评估II（APACHE II）评分的平均值为17分，脓毒症相关器官功能衰竭评估（SOFA）评分为7分。总体死亡率和14天死亡率分别为75%和48%。47例（78%）患者接受了治疗，其中74%接受了复方新诺明治疗。与死亡率相关的独立危险因素为SOFA指数>6分（P=0.005）和感染性休克（P=0.03）。Kaplan-Meier估计曲线显示，APACHE II评分>20分且SOFA评分>10分的患者在嗜麦芽窄食单胞菌首次培养阳性后21天的生存机会分别低于8%和10%（P≤0.001）。我们的结果表明，与嗜麦芽窄食单胞菌感染患者预后相关的独立因素是感染性休克和较高的SOFA指数。
