Hotta Go, Matsumura Yasufumi, Kato Karin, Nakano Satoshi, Yunoki Tomoyuki, Yamamoto Masaki, Nagao Miki, Ito Yutaka, Takakura Shunji, Ichiyama Satoshi
Kyoto University Graduate School of Medicine, Department of Clinical Laboratory Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, Japan.
Kyoto University Graduate School of Medicine, Department of Respiratory Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, Japan.
PLoS One. 2014 Nov 6;9(11):e112208. doi: 10.1371/journal.pone.0112208. eCollection 2014.
Stenotrophomonas maltophilia (SM) is an important nosocomial pathogen that exhibits intrinsic resistance to various antimicrobial agents. However, the risk factors for SM bacteraemia have not been sufficiently evaluated. From January 2005 to September 2012, we retrospectively compared the clinical backgrounds and outcomes of SM bacteraemic patients (SM group) with those of bacteraemic patients due to Pseudomonas aeruginosa (PA group) or Acinetobacter species (AC group). DNA genotyping of the SM isolates using the Diversilab system was performed to investigate the genetic relationships among the isolates. The SM, PA, and AC groups included 54, 167, and 69 patients, respectively. Nine of 17 patients in the SM group receiving trimethoprim-sulfamethoxazole prophylaxis developed SM bacteraemia. Independent risk factors for SM bacteraemia were the use of carbapenems and antipseudomonal cephalosporins and SM isolation within 30 days prior to the onset of bacteraemia. Earlier SM isolation was observed in 32 of 48 patients (66.7%) with SM bacteraemia who underwent clinical microbiological examinations. Of these 32 patients, 15 patients (46.9%) had the same focus of bacteraemia as was found in the previous isolation site. The 30-day all-cause mortality rate among the SM group (33.3%) was higher than that of the PA group (21.5%, p = 0.080) and the AC group (17.3%, p = 0.041). The independent factor that was associated with 30-day mortality was the SOFA score. DNA genotyping of SM isolates and epidemiological data suggested that no outbreak had occurred. SM bacteraemia was associated with high mortality and should be considered in patients with recent use of broad-spectrum antibiotics or in patients with recent isolation of the organism.
嗜麦芽窄食单胞菌（SM）是一种重要的医院病原体，对多种抗菌药物表现出固有耐药性。然而，SM菌血症的危险因素尚未得到充分评估。2005年1月至2012年9月，我们回顾性比较了SM菌血症患者（SM组）与铜绿假单胞菌菌血症患者（PA组）或不动杆菌属菌血症患者（AC组）的临床背景和结局。使用Diversilab系统对SM分离株进行DNA基因分型，以研究分离株之间的遗传关系。SM组、PA组和AC组分别包括54例、167例和69例患者。SM组中17例接受甲氧苄啶-磺胺甲恶唑预防的患者中有9例发生了SM菌血症。SM菌血症的独立危险因素是碳青霉烯类和抗假单胞菌头孢菌素的使用以及菌血症发作前30天内分离出SM。在48例接受临床微生物学检查的SM菌血症患者中，有32例（66.7%）较早分离出SM。在这32例患者中，有15例（46.9%）的菌血症病灶与先前分离部位相同。SM组的30天全因死亡率（33.3%）高于PA组（21.5%，p = 0.080）和AC组（17.3%，p = 0.041）。与30天死亡率相关的独立因素是序贯器官衰竭评估（SOFA）评分。SM分离株的DNA基因分型和流行病学数据表明未发生暴发。SM菌血症与高死亡率相关，近期使用广谱抗生素的患者或近期分离出该菌的患者应予以考虑。
