Koh Matthew Chung Yi, Ngiam Jinghao Nicholas, Lum Lionel Hon-Wai, Smitasin Nares, Chew Ka Lip, Allen David Michael
Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore.
Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Infect Public Health. 2025 Aug;18(8):102829. doi: 10.1016/j.jiph.2025.102829. Epub 2025 May 14.
Stenotrophomonas maltophilia is an important nosocomial pathogen. Bacteraemia is associated with significant morbidity, despite antibiotic therapy. Optimal treatment strategies for Stenotrophomonas maltophilia bacteraemia remain ill-defined. Thus, we retrospectively examined the clinical presentation, microbiological characteristics, treatment options to identify risk factors for mortality.
We performed a retrospective single-centre analysis of Stenotrophomonas maltophilia bacteraemia from 1 Jan 2012-30 Jun 2024. Data on the clinical presentation, source of infection, microbiological characteristics, treatment strategies and clinical outcomes were tabulated. Risk factors for in-hospital all-cause mortality were identified by appropriate univariate and multivariable analyses.
There were 197 bacteraemia episodes. In-hospital mortality was 41.6 % (n = 82), and did not change significantly over the years. Patients who died were more likely to have prior carbapenem exposure (81.7 % vs 53.0 %, p < 0.001), presentation in an intensive care (ICU) setting (73.2 % vs 15.7 %, p < 0.001), and had a longer duration of fever (8.5 ± 2.5 vs 3.0 ± 3.8 days, p < 0.001). Microbiological isolation from additional sites other than the blood (e.g. sputum culture positivity) also correlated with mortality (39.0 % vs 7.8 %, p < 0.001). Over time, proportion of isolates resistant to fluoroquinolones increased. An initial antimicrobial choice containing trimethoprim-sulfamethoxazole appeared to be more likely to be associated with survival. Only 13 patients (6.6 %) received dual antibiotics initially, so it was unclear if this was associated with better outcomes. On multivariable analysis, ICU onset, elevated C-reactive protein, longer duration of fever and an absence of intervention for source control remained independently associated with mortality.
Source control of infection may be critical in improving survival in Stenotrophomonas maltophilia bacteraemia. Future prospective studies should validate important risk factors for mortality and define optimal antimicrobial treatment strategies.
嗜麦芽窄食单胞菌是一种重要的医院感染病原体。尽管进行了抗生素治疗，但菌血症仍与显著的发病率相关。嗜麦芽窄食单胞菌菌血症的最佳治疗策略仍不明确。因此，我们进行了回顾性研究，以检查临床表现、微生物学特征、治疗选择，从而确定死亡的危险因素。
我们对2012年1月1日至2024年6月30日期间的嗜麦芽窄食单胞菌菌血症进行了回顾性单中心分析。将临床表现、感染源、微生物学特征、治疗策略和临床结果的数据制成表格。通过适当的单变量和多变量分析确定院内全因死亡的危险因素。
共有197例菌血症发作。院内死亡率为41.6%（n = 82），多年来没有显著变化。死亡患者更有可能曾接受过碳青霉烯类药物治疗（81.7%对53.0%，p < 0.001），在重症监护病房（ICU）就诊（73.2%对15.7%，p < 0.001），且发热持续时间更长（8.5 ± 2.5天对3.0 ± 3.8天，p < 0.001）。从血液以外的其他部位进行微生物分离（例如痰培养阳性）也与死亡率相关（39.0%对7.8%，p < 0.001）。随着时间的推移，对氟喹诺酮类耐药的分离株比例增加。最初选择含有甲氧苄啶 - 磺胺甲恶唑的抗菌药物似乎更有可能与生存相关。只有13例患者（6.6%）最初接受了联合抗生素治疗，因此尚不清楚这是否与更好的结果相关。多变量分析显示，ICU发病、C反应蛋白升高、发热持续时间延长以及未进行感染源控制干预仍然与死亡率独立相关。
控制感染源可能对提高嗜麦芽窄食单胞菌菌血症患者的生存率至关重要。未来的前瞻性研究应验证重要的死亡危险因素，并确定最佳的抗菌治疗策略。
