Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, Tropical Medicine Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Microbiol Immunol Infect. 2014 Feb;47(1):28-35. doi: 10.1016/j.jmii.2012.08.014. Epub 2012 Oct 2.
BACKGROUND/PURPOSE: Stenotrophomonas maltophilia has been recognized as an important nosocomial pathogen, but few reports have discussed S. maltophilia infection in the community settings. This study aimed to reveal characteristics of patients with community-onset S. maltophilia bloodstream infection (SMBSI), to specify the subgroup of healthcare-associated (HCA) infection in the community-onset group and to compare them with hospital-acquired (HA) SMBSI patients.
Medical charts of adult patients with SMBSI presenting to a medical center in southern Taiwan from May 2008 to October 2011 were reviewed and analyzed retrospectively.
Among 153 patients, we observed a high percentage (38.6%) of SMBSI to be community onset. Among community-onset SMBSI, 45.8% were community-acquired (CA) and 54.2% were HCA. The crude mortality rates were 11.1%, 18.8%, and 60.6% in the CA, HCA, and HA groups, respectively. Structural/mechanical abnormalities were observed in 32.7% of all cases, and 60% of those were related to malignancy. Independent risk factors for mortality in community-onset SMBSI were liver cirrhosis, liver metastasis, and a high Pitt bacteremia score, whereas structural/mechanical abnormalities and a high Pitt bacteremia score related to increased mortality in HA SMBSI.
Community-onset S. maltophilia infection deserves attention. Patients with community-onset SMBSI have reduced disease severity and lower mortality rate when compared to HA SMBSI. Underlying structural/mechanical abnormalities, especially those caused by malignancies, are common in SMBSI cases and should be investigated when bacteremia occurs.
背景/目的：嗜麦芽寡养单胞菌已被认为是一种重要的医院获得性病原体，但很少有报道讨论社区环境中的嗜麦芽寡养单胞菌感染。本研究旨在揭示社区获得性嗜麦芽寡养单胞菌血流感染（SMBSI）患者的特征，确定社区获得性感染组中与医疗保健相关（HCA）感染的亚组，并将其与医院获得性（HA）SMBSI 患者进行比较。
回顾性分析 2008 年 5 月至 2011 年 10 月期间，一位来自台湾南部医学中心的成人 SMBSI 患者的病历。
在 153 名患者中，我们观察到 SMBSI 中有 38.6%的患者为社区发病。在社区获得性 SMBSI 中，45.8%为社区获得性（CA），54.2%为 HCA。CA、HCA 和 HA 组的粗死亡率分别为 11.1%、18.8%和 60.6%。所有病例中有 32.7%观察到结构/机械异常，其中 60%与恶性肿瘤有关。社区获得性 SMBSI 死亡的独立危险因素是肝硬化、肝转移和高 Pitt 菌血症评分，而结构/机械异常和高 Pitt 菌血症评分与 HA SMBSI 死亡率增加有关。
社区获得性嗜麦芽寡养单胞菌感染值得关注。与 HA SMBSI 相比，社区获得性 SMBSI 患者的疾病严重程度较低，死亡率较低。结构/机械异常，尤其是由恶性肿瘤引起的异常，在 SMBSI 病例中很常见，当发生菌血症时应进行调查。
