Ebara Hirotaka, Hagiya Hideharu, Haruki Yuto, Kondo Eisei, Otsuka Fumio
Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
Intern Med. 2017;56(2):137-142. doi: 10.2169/internalmedicine.56.6141. Epub 2017 Jan 15.
Objective Stenotrophomonas maltophilia is an emerging nosocomial pathogen that causes fatal infections in critically ill or immunocompromised patients. S. maltophilia bacteremia (SMB) is a rare condition, and its clinical characteristics in Japanese settings are not well known. Methods The medical charts of patients with SMB were retrospectively reviewed at two medical facilities (Okayama University Hospital and Tsuyama Chuo Hospital) for seven years. The data were analyzed along with those previously reported from other Japanese facilities. Result A total of 181 patients (110 men and 71 women) were evaluated. The major underlying diseases included hematologic malignancy (36.5%), solid organ malignancy (25.4%), and neutropenia (31.5%). The recent use of carbapenem was seen in 56.9% of the cases in total, and more than one-third of the patients in our hospitals were treated with carbapenem at the onset of SMB. Of 28 (63.6%) of 44 cases treated for S. maltophilia, those who did not survive were more likely to have been treated with broad-spectrum antibiotics. A multivariate analysis revealed that a higher updated Charlson Comorbidity Index [odds ratio (95% confidence interval), 1.75 (1.11-2.75); p=0.015] and intubation [odds ratio (95% confidence interval), 12.6 (1.62-97.9); p=0.016] were associated with mortality in our cases. Pathogens were often resistant to ceftazidime but susceptible to minocycline, trimethoprim/sulfamethoxazole, and fluoroquinolones. The overall mortality rates within 30 and 90 days were 37.5% and 62.5%, respectively. Conclusion The clinical characteristics of SMB in Japanese cases were similar to those reported from other countries. Clinicians should be aware that breakthrough infection by S. maltophilia may occur during administration of carbapenem.
目的 嗜麦芽窄食单胞菌是一种新出现的医院病原体，可在重症或免疫功能低下患者中引起致命感染。嗜麦芽窄食单胞菌菌血症（SMB）是一种罕见病症，其在日本环境中的临床特征尚不清楚。方法 对两家医疗机构（冈山大学医院和津山中央医院）7年间SMB患者的病历进行回顾性研究。将这些数据与之前其他日本医疗机构报告的数据一起进行分析。结果 共评估了181例患者（110例男性和71例女性）。主要基础疾病包括血液系统恶性肿瘤（36.5%）、实体器官恶性肿瘤（25.4%）和中性粒细胞减少（31.5%）。总共56.9%的病例近期使用过碳青霉烯类药物，我院超过三分之一的患者在SMB发病时接受过碳青霉烯类药物治疗。在44例接受嗜麦芽窄食单胞菌治疗的病例中，28例（63.6%）死亡，未存活者更有可能接受过广谱抗生素治疗。多因素分析显示，较高的更新Charlson合并症指数[比值比（95%置信区间），1.75（1.11 - 2.75）；p = 0.015]和插管[比值比（95%置信区间），12.6（1.62 - 97.9）；p = 0.016]与我们病例中的死亡率相关。病原体通常对头孢他啶耐药，但对米诺环素、甲氧苄啶/磺胺甲恶唑和氟喹诺酮敏感。30天和90天内的总死亡率分别为37.5%和62.5%。结论 日本病例中SMB的临床特征与其他国家报告的相似。临床医生应意识到在使用碳青霉烯类药物期间可能发生嗜麦芽窄食单胞菌的突破性感染。
