Ventilator-associated pneumonia due to Stenotrophomonas maltophilia: Risk factors and outcome. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Ibn Saied, Wafa; Merceron, Sybille; Schwebel, Carole; Le Monnier, Alban; Oziel, Johana; Garrouste-Orgeas, Maité; Marcotte, Guillaume; Ruckly, Stéphane; Souweine, Bertrand; Darmon, Michael; Bouadma, Lila; de Montmollin, Etienne; Mourvillier, Bruno; Reignier, Jean; Papazian, Laurent; Siami, Shidasp; Azoulay, Elie; Bédos, Jean-Pierre; Timsit, Jean-Francois
• Is Part Of: Journal of infection. Volume 80:Issue 3(2020)
• Page Start: 279
• Page End: 285
• Publication Date: 2020-03
• Subjects: ICU -- Mortality -- Risk factors -- VAP -- GNB -- SM; VAP Ventilator–acquired pneumonia -- ICU intensive care unit -- SM-VAP Stenotrophomonas maltophilia ventilator–acquired pneumonia -- Others-VAP Others microorganisms ventilator–acquired pneumonia -- Pyo-VAP Pseudomonas aeruginosa ventilator–acquired pneumonia; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2019.10.021
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: SM-VAP occurred lately after the onset of mechanichal ventilation. Exposure to carbapenem and carboxy- or ureido-penicillin during the week before VAP and the severity of disease with respiratory and hematological failures were independent risk factors for the SM-VAP occurrence. The prognosis of patients with SM-VAP was poor and not modified by the adequacy of antimicrobial therapy. Antibiotics exposure the week before VAP and the severity of disease were independent risk factors for the SM-VAP occurrence. Abstract: Background: Stenotrophomonas maltophilia ( SM ) is increasingly identified in intensive care unit (ICU). This study aim to identify risk factors for SM ventilator-associated pneumonia (VAP) and whether it affects ICU mortality Methods: Two nested matched case-control studies were performed based in OUTCOMEREA database. The first episodes of SM -VAP patients were matched with two different control groups: VAP due to other micro-organisms (VAP-other) and Pseudomonas aeruginosa VAP (Pyo-VAP). Matching criteria were the hospital, the SAPS II, and the previous duration of mechanical ventilation (MV). Results: Of the 102 SM -VAP patients (6.2% of all VAP patients), 92 were matched with 375 controls for the SM -VAP/other-VAP matching and 84 with 237 controls for the SM -VAP/ Pyo -VAP matching. SM -VAP risk factors were an exposition to ureido/carboxypenicillin or carbapenem during the week before VAP, and respiratory and coagulation components of SOFA score upper to 2 before VAP. SM -VAP received early adequate therapy in 70 cases (68.6%). Risk factors for Day-30 were age (OR = 1.03; p < 0.01) and Chronic heart failure (OR = 3.15; p < 0.01). Adequate treatment, either monotherapy or combination of antimicrobials, did not modify mortality. There was no difference in 30-day mortality, but 60-day mortality was higher in patients with SM -VAP compared to Other-VAP ( P = 0.056). Conclusions: In a large series, independent risk factors for the SM -VAP were ureido/carboxypenicillin or carbapenem exposure the week before VAP, and respiratory and coagulation components of the SOFA score > 2 before VAP. Mortality risk factors of SM-VAP were age and chronic heart failure. Adequate treatment did not improve SM -VAP prognosis. Graphical abstract: Image, graphical abstract